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General NPI Number Information
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NPI Number | 1154491967
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Entity Type | Organization
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Legal Business Name | CLAY SUPERMARKET INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 2200 MAIN ST
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City | CLAY
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State | WV
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Zip | 25043-0609
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Country | US
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Telephone | 304-587-7327
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Fax | 304-587-4888
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | CLAY
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State | WV
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Zip | 25043-0609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DREAMA CLIFTON
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Credential | RPH
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Telephone | 304-587-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | SP0550942
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License Number State | WV
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