Provider Demographics
NPI:1083045322
Name:SMITH, CLAYTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:
Last Name:SMITH
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 1:66 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1337
Mailing Address - Country:US
Mailing Address - Phone:207-453-4411
Mailing Address - Fax:207-453-6612
Practice Address - Street 1:66 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1337
Practice Address - Country:US
Practice Address - Phone:207-453-4411
Practice Address - Fax:207-453-6612
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist