Healthcare Provider Details

I. General information

NPI: 1629270285
Provider Name (Legal Business Name): BERTON CLAY STIMSON PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 WILMA RUDOLPH BLVD
CLARKSVILLE TN
37040-5031
US

IV. Provider business mailing address

3050 WILMA RUDOLPH BLVD
CLARKSVILLE TN
37040-5031
US

V. Phone/Fax

Practice location:
  • Phone: 931-552-0264
  • Fax:
Mailing address:
  • Phone: 931-552-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8535
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: