Healthcare Provider Details

I. General information

NPI: 1164578902
Provider Name (Legal Business Name): CLAYTON PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LAWSON BLVD
CLAYTON OK
74536-0517
US

IV. Provider business mailing address

102 LAWSON BLVD
CLAYTON OK
74536-0517
US

V. Phone/Fax

Practice location:
  • Phone: 918-569-4884
  • Fax: 918-569-4660
Mailing address:
  • Phone: 918-569-4884
  • Fax: 918-569-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number534300
License Number StateOK

VIII. Authorized Official

Name: MR. JEFFREY S YANCHICK
Title or Position: OWNER/PIC
Credential: MPH DPH
Phone: 918-569-4884