Healthcare Provider Details

I. General information

NPI: 1780139949
Provider Name (Legal Business Name): CLAYWELL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 12/29/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 LINCOLN PARK RD
SPRINGFIELD KY
40069
US

IV. Provider business mailing address

202 W STEPHEN FOSTER AVE
BARDSTOWN KY
40004-1478
US

V. Phone/Fax

Practice location:
  • Phone: 859-481-7100
  • Fax: 859-481-7104
Mailing address:
  • Phone: 502-348-6623
  • Fax: 502-348-7704

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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