Clover Care Pharmacy Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

CLOVER CARE PHARMACY INC

Practice address

266 S Harvard Blvd Ste 140
Los Angeles, CA 90004-4389

Phone

(213) 384-8763

Fax

(213) 384-7521

NPI assigned

Apr 16, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Sang J. LeeNPI 1114936945

Title

President/Pic

Phone

(213) 384-8763

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• CLOVER CARE PHARMACY INC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sang Jung Lee, PHARMACIST

  • Pharmacist
  • Los Angeles, CA
  • NPI 1114936945
  NPD Authorized official
• Grace Yaisol Kim

  • Pharmacist
  • Los Angeles, CA
  • NPI 1194460063
  NPD

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

{
    "created_epoch": "1586995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1164042453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD STE 140",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044389",
            "telephone_number": "213-384-8763",
            "fax_number": "213-384-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 S HARVARD BLVD STE 140",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044389",
            "telephone_number": "213-384-8763",
            "fax_number": "213-384-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER CARE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-16",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/PIC",
        "authorized_official_telephone_number": "213-384-8763",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY PERMIT",
            "identifier": "57713",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLOVER CARE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CLOVER CARE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Francis Cloughesy, MD
• Cerisa Clouse, DDS
• Judy Frances Clouse, MSN
• Ashley Cloutier
• Logan Cloutier
• David E Clower
• CMC Enterprise Inc
• CMC Enterprise Inc
• CMC Enterprise, Inc.
• CMC Pulmonary Lab

• Long Term Care Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.