Healthcare Provider Details

I. General information

NPI: 1164113189
Provider Name (Legal Business Name): CLAYWELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CHAPLIN RD
BLOOMFIELD KY
40008-7125
US

IV. Provider business mailing address

PO BOX 398
BLOOMFIELD KY
40008-0398
US

V. Phone/Fax

Practice location:
  • Phone: 502-252-8242
  • Fax: 502-252-7556
Mailing address:
  • Phone: 502-252-8242
  • Fax: 502-252-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALYSON R ROBY
Title or Position: OWNER
Credential:
Phone: 502-348-6623