Healthcare Provider Details

I. General information

NPI: 1063518082
Provider Name (Legal Business Name): CLOVER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3091
US

IV. Provider business mailing address

112 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3091
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-6311
  • Fax: 925-939-5639
Mailing address:
  • Phone: 925-939-6311
  • Fax: 925-939-5639

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 NumberPHY54381
License Number StateCA

VIII. Authorized Official

Name: GERALD YU TUNG
Title or Position: PRESIDENT
Credential:
Phone: 925-939-6311