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General NPI Number Information
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NPI Number | 1558098210
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Entity Type | Individual
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Provider Name | VAN ALLEN CLAYTON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 1208 W MAIN ST
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-1005
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Country | US
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Telephone | 870-886-8100
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Fax | 870-886-9200
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Provider Business Mailing Address
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Address Line | 124 CHARLESTON DR
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-8552
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Country | US
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Telephone | 870-637-2162
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Fax | 870-886-9200
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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 | PD08346
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License Number State | AR
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