Provider Demographics
NPI:1013210699
Name:WEST, CLAY (RPH)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9278
Mailing Address - Country:US
Mailing Address - Phone:606-739-9357
Mailing Address - Fax:
Practice Address - Street 1:370 DIEDERICH BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7008
Practice Address - Country:US
Practice Address - Phone:606-325-0611
Practice Address - Fax:606-326-1021
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY010901OtherSTATE LICENSE NUMBER