Provider Demographics
NPI:1083021521
Name:CLAYVILLE, NICHOLAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CLAYVILLE
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 1:3909 10TH ST SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2189
Mailing Address - Country:US
Mailing Address - Phone:253-848-2011
Mailing Address - Fax:253-848-3119
Practice Address - Street 1:3909 10TH ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2189
Practice Address - Country:US
Practice Address - Phone:253-848-2011
Practice Address - Fax:253-848-3119
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH604487941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist