Healthcare Provider Details

I. General information

NPI: 1295645166
Provider Name (Legal Business Name): CLAYTON PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PHOENIX BLVD STE 208
COLLEGE PARK GA
30349-5557
US

IV. Provider business mailing address

1800 PHOENIX BLVD STE 208
COLLEGE PARK GA
30349-5557
US

V. Phone/Fax

Practice location:
  • Phone: 678-759-3952
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: SRIKANTH RAMINENI
Title or Position: OWNER
Credential:
Phone: 770-630-3623