Provider Demographics
NPI:1003025115
Name:LEDFORD, CLINT LANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:LANE
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHWAY 64 E
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-5526
Mailing Address - Country:US
Mailing Address - Phone:828-389-2804
Mailing Address - Fax:828-389-2832
Practice Address - Street 1:230 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-5526
Practice Address - Country:US
Practice Address - Phone:828-389-2804
Practice Address - Fax:828-389-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023079183500000X
NC19422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist