Healthcare Provider Details

I. General information

NPI: 1184995029
Provider Name (Legal Business Name): CLAYTON PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 1ST ST
SUMNER IA
50674-1430
US

IV. Provider business mailing address

100 E 1ST ST
SUMNER IA
50674-1430
US

V. Phone/Fax

Practice location:
  • Phone: 563-578-5142
  • Fax: 563-578-5190
Mailing address:
  • Phone: 563-578-5142
  • Fax: 563-578-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number43
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2133583
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: CHRISTOPHER EDMUND CLAYTON
Title or Position: TREAURER
Credential:
Phone: 319-939-2569