Provider Demographics
NPI:1407899461
Name:CLAY, AUBREY SAMUEL JR (RPH)
Entity type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:SAMUEL
Last Name:CLAY
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25110 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-2048
Mailing Address - Country:US
Mailing Address - Phone:804-478-4739
Mailing Address - Fax:804-733-9170
Practice Address - Street 1:518 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5038
Practice Address - Country:US
Practice Address - Phone:804-733-5888
Practice Address - Fax:804-733-9170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202005227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist