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NPI Code Detail

MEDICARE: MR. BILLY CLAY CLANTON JR. R.PH.

MEDICARE: MR. BILLY CLAY CLANTON JR. R.PH.
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
1183500000XPharmacistE-09006MS
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistE-09006MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1E09006OTHERMSPHARMACY LICENSE

General Provider Information

NPI Number : 1528289709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BILLY CLAY CLANTON JR. R.PH.
Provider Business Mailing Address
First Line : 214 SUMMER HILL ROAD
Second Line :
City : MADISON
State : MS
Zip : 39110
Country : US
Telephone Number : 601-607-7137
Fax Number :
Provider Business Practice Location Address
First Line : 6745 S SIWELL RD
Second Line :
City : BYRAM
State : MS
Zip : 39272-8747
Country : US
Telephone Number : 601-863-2004
Fax Number : 601-863-2016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 01/13/2020

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