MEDICARE: CLYDE NORRIS DEARMAN PHARMD, AE-C, CDM

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	1835P1200X	Pharmacotherapy Pharmacist	14413	LA

General Provider Information

NPI Number	:	1427207661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDE NORRIS DEARMAN PHARMD, AE-C, CDM

Provider Business Mailing Address
First Line	:	130 DESIARD ST STE 300
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7363
Country	:	US
Telephone Number	:	318-361-0900
Fax Number	:	318-361-2185

Provider Business Practice Location Address
First Line	:	130 DESIARD ST STE 300
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7363
Country	:	US
Telephone Number	:	318-361-0900
Fax Number	:	318-361-2185

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	02/05/2010

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