MEDICARE: MR. RONALD HARRIS CLAYTON

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	PS0013456	FL

General Provider Information

NPI Number	:	1467590943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD HARRIS CLAYTON

Provider Business Mailing Address
First Line	:	305 WILLIAMSBURG DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4525
Country	:	US
Telephone Number	:	850-932-6201
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3351
Country	:	US
Telephone Number	:	850-932-3581
Fax Number	:	850-932-8137

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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