Healthcare Provider Details

I. General information

NPI: 1114407913
Provider Name (Legal Business Name): BRIAN CLUFF PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEDICINE WAY ROAD
PERIDOT AZ
85542
US

IV. Provider business mailing address

PO BOX 787
PERIDOT AZ
85542-0787
US

V. Phone/Fax

Practice location:
  • Phone: 928-475-1400
  • Fax:
Mailing address:
  • Phone: 928-475-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023471
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: