MEDICARE: MARTINIQUE LIVINGSTON CLAY PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5166455-1701	UT

General Provider Information

NPI Number	:	1942937115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTINIQUE LIVINGSTON CLAY PHARM D

Provider Business Mailing Address
First Line	:	200 N STATION PKWY
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2881
Country	:	US
Telephone Number	:	801-928-2626
Fax Number	:	801-928-2639

Provider Business Practice Location Address
First Line	:	200 N STATION PKWY
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2881
Country	:	US
Telephone Number	:	801-928-2626
Fax Number	:	801-928-2639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2022
Last Update Date	:	08/06/2022

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