Provider Demographics
NPI:1073812475
Name:CLAYCOMB, DAVID SCOTT (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:CLAYCOMB
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 1:942 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2107
Mailing Address - Country:US
Mailing Address - Phone:814-341-6615
Mailing Address - Fax:
Practice Address - Street 1:942 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2107
Practice Address - Country:US
Practice Address - Phone:814-341-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038923L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist