Provider Demographics
NPI:1023550076
Name:CLODFELTER, CLARENCE LEE III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LEE
Last Name:CLODFELTER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:CLODFELTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9440 OTTOWAY CT
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9369
Mailing Address - Country:US
Mailing Address - Phone:757-593-1924
Mailing Address - Fax:
Practice Address - Street 1:1840 TAPPAHANNOCK BLVD
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist