Healthcare Provider Details

I. General information

NPI: 1154312254
Provider Name (Legal Business Name): CLEAR SCRIPT COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2005
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15175 LAKESHORE DR
CLEARLAKE CA
95422-8106
US

IV. Provider business mailing address

PO BOX 7070
CLEARLAKE CA
95422-7070
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-6440
  • Fax: 707-994-8425
Mailing address:
  • Phone: 707-994-6440
  • Fax: 707-944-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46732
License Number StateCA

VIII. Authorized Official

Name: GURINDER GREWAL
Title or Position: PRESIDENT
Credential:
Phone: 707-994-6440