Healthcare Provider Details

I. General information

NPI: 1942319702
Provider Name (Legal Business Name): VLS CLAYWORTH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20353 LAKE CHABOT RD STE 101
CASTRO VALLEY CA
94546-5392
US

IV. Provider business mailing address

14183 CATALINA ST
SAN LEANDRO CA
94577-5509
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-9402
  • Fax: 510-537-1487
Mailing address:
  • Phone: 510-352-5400
  • Fax: 510-352-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51452
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUDHIR REDDY
Title or Position: OWNER
Credential: PHARMD
Phone: 510-537-9402