Organization
CLAY MEDI CENTER PHARMACY LLC
Active
Organization
CLAY MEDI CENTER PHARMACY LLC
Active
Other names
CLAY MEDICENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT CRUSE (OWNER/MANAGER)
(502) 432-3621
Entity
Organization
Contact information
Practice address
509 MEMORIAL DR, MANCHESTER, KY 40962-6195
(606) 598-7933
(606) 598-1887
Mailing address
509 MEMORIAL DR, MANCHESTER, KY 40962-6195
(606) 598-7933
(606) 598-1887
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07541
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2139171
PK
—
Enumeration date
12/17/2012
Last updated
06/20/2013
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