=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043142706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAYTON BOQUET
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2026
-----------------------------------------------------
Last Update Date | 05/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 E GOODE ST
-----------------------------------------------------
City | QUITMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75783-2539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-763-1420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23840 STALLION PARK PL
-----------------------------------------------------
City | LINDALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75771-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 77129
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------