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NPI Code Detail

MEDICARE: CLARENCE M CLIFTON RPH

MEDICARE:   CLARENCE M CLIFTON  RPH
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
1183500000XPharmacist03327018OH
2183500000XPharmacist007258KY

General Provider Information

NPI Number : 1619254109
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARENCE M CLIFTON RPH
Provider Business Mailing Address
First Line : 4497 FAR HILLS AVE
Second Line :
City : KETTERING
State : OH
Zip : 45429-2405
Country : US
Telephone Number : 937-396-1358
Fax Number : 937-396-1363
Provider Business Practice Location Address
First Line : 4497 FAR HILLS AVE
Second Line :
City : KETTERING
State : OH
Zip : 45429-2405
Country : US
Telephone Number : 937-396-1358
Fax Number : 937-396-1363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2011
Last Update Date : 11/10/2011

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