Healthcare Provider Details

I. General information

NPI: 1235990276
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 STACY BURK DRIVE
FLORA IL
62839
US

IV. Provider business mailing address

PO BOX 280
FLORA IL
62839-0280
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-1600
  • Fax: 618-844-8625
Mailing address:
  • Phone: 618-662-2131
  • Fax: 618-662-1482

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: JENNIFER VENABLE
Title or Position: CFO
Credential:
Phone: 618-662-2191