MEDICARE: VLS CLAYWORTH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PHY51452	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141315	OTHER		PK

General Provider Information

NPI Number	:	1942319702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VLS CLAYWORTH PHARMACY INC

Provider Business Mailing Address
First Line	:	14183 CATALINA ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5509
Country	:	US
Telephone Number	:	510-352-5400
Fax Number	:	510-352-1372

Provider Business Practice Location Address
First Line	:	20353 LAKE CHABOT RD
Second Line	:	STE 101
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5392
Country	:	US
Telephone Number	:	510-537-9402
Fax Number	:	510-537-1487

Authorized Official
Title or Position	:	OWNER
Name	:	SUDHIR REDDY
Credential	:	PHARMD
Telephone Number	:	510-537-9402

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/03/2015

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Directions to “VLS CLAYWORTH PHARMACY INC ” Practice Location

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