Healthcare Provider Details

I. General information

NPI: 1437273224
Provider Name (Legal Business Name): CLINTON AND CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 NATIONAL BLVD STE L STE L
LOS ANGELES CA
90064-3668
US

IV. Provider business mailing address

11700 NATIONAL BLVD STE L STE L
LOS ANGELES CA
90064-3668
US

V. Phone/Fax

Practice location:
  • Phone: 310-737-7277
  • Fax: 310-737-7977
Mailing address:
  • Phone: 310-737-7277
  • Fax: 310-737-7977

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 NumberPHY46250
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONALD CLINTON
Title or Position: PHARMACY MGR
Credential: RPH
Phone: 310-737-7277