Organization
CLAY SUPERMARKET INC
Active
Other names
CLAY FOODLAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DREAMA CLIFTON RPH (OWNER)
(304) 587-2777
Entity
Organization
Contact information
Practice address
2200 MAIN ST, CLAY, WV 25043-0609
(304) 587-7327
(304) 587-4888
Mailing address
PO BOX 609, CLAY, WV 25043-0609
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0550942
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0144001000
—
WV
01
—
5008013
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/09/2006
Last updated
09/10/2009
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