Provider Demographics
NPI:1336207703
Name:CLAYTON & EDWARD CHEMISTS, INC.
Entity type:Organization
Organization Name:CLAYTON & EDWARD CHEMISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-737-1147
Mailing Address - Street 1:1004 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4203
Mailing Address - Country:US
Mailing Address - Phone:212-737-1147
Mailing Address - Fax:212-737-8580
Practice Address - Street 1:1004 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4203
Practice Address - Country:US
Practice Address - Phone:212-737-1147
Practice Address - Fax:212-737-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0276773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02748772Medicaid
NY02748772Medicaid