Healthcare Provider Details

I. General information

NPI: 1740812155
Provider Name (Legal Business Name): CLOVER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 THORNTON AVE STE E
NEWARK CA
94560-3700
US

IV. Provider business mailing address

6170 THORNTON AVE STE E
NEWARK CA
94560-3700
US

V. Phone/Fax

Practice location:
  • Phone: 510-961-1288
  • Fax:
Mailing address:
  • Phone: 510-961-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CONNIE MAN
Title or Position: OWNER
Credential: PHARMD
Phone: 510-961-1288