MEDICARE: JOHN CLYDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-15421	KS

General Provider Information

NPI Number	:	1003206269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CLYDE

Provider Business Mailing Address
First Line	:	101 BLUEMONT AVE
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5093
Country	:	US
Telephone Number	:	785-776-4841
Fax Number	:	785-776-4842

Provider Business Practice Location Address
First Line	:	101 BLUEMONT AVE
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-5093
Country	:	US
Telephone Number	:	785-776-4841
Fax Number	:	785-776-4842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	04/12/2026

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Directions to “ JOHN CLYDE ” Practice Location

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