Healthcare Provider Details

I. General information

NPI: 1144332826
Provider Name (Legal Business Name): CLIFFORD STEPHEN NASDAHL PHARM.D.,BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CLIFFORD STEPHEN NASDAHL PHARM.D.,BCPP

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE DEPARTMENT OF PSYCHIATRY/PHARMACY
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

493 E RACQUET CLUB PL
MEMPHIS TN
38117-4524
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-577-7429
Mailing address:
  • Phone: 901-683-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRPH32359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: