Clover Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54381 Issued in CA

Legal business name

CLOVER PHARMACY INC

Practice address

112 La Casa Via
Ste 100
Walnut Creek, CA 94598-3091

Phone

(925) 939-6311

Fax

(925) 939-5639

NPI assigned

Sep 16, 2006

Last updated

Jan 29, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gerald Yu Tung

Title

President

Phone

(925) 939-6311

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1063518082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 LA CASA VIA",
            "address_2": "STE 100",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983091",
            "telephone_number": "925-939-6311",
            "fax_number": "925-939-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 LA CASA VIA",
            "address_2": "STE 100",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983091",
            "telephone_number": "925-939-6311",
            "fax_number": "925-939-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "TUNG",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "YU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-939-6311"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063518082",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159898",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Clemons, MD
• Thomas L Clennell, D.P.T.
• Jessica M Clima, MD
• Sienna Climons
• Amy K Clouse, MD
• Janice Cobbs
• Ericka Coe, LCSW
• Randall W Coeshott, PSY 22560
• Amanda Coey, HIGH SCHOOL DIPLOMA
• Jennifer Lorraine Coggiola, SLP

• Community/Retail Pharmacy in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.