Provider Demographics
NPI:1689402133
Name:CLAY PHARMACY INC
Entity type:Organization
Organization Name:CLAY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:N
Authorized Official - Last Name:NZENGUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-379-8111
Mailing Address - Street 1:3100 MICHELLE CT
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8714
Mailing Address - Country:US
Mailing Address - Phone:301-379-8111
Mailing Address - Fax:
Practice Address - Street 1:116 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3404
Practice Address - Country:US
Practice Address - Phone:301-379-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy