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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