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General NPI Number Information
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NPI Number | 1003210766
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Entity Type | Individual
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Provider Name | MARK CLAYTON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 767 ADMIRAL AVE
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City | TULARE
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State | CA
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Zip | 93274-1269
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Country | US
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Telephone | 503-258-7114
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Fax |
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Provider Business Mailing Address
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Address Line | 767 ADMIRAL AVE
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City | TULARE
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State | CA
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Zip | 93274-1269
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Country | US
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Telephone | 503-258-7114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 71459
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00066399
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S018484
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License Number State | AZ
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