Provider Demographics
NPI:1124600507
Name:CLARDY, CLAY J (RPH)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:J
Last Name:CLARDY
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 1:907 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-2325
Mailing Address - Country:US
Mailing Address - Phone:502-931-6144
Mailing Address - Fax:
Practice Address - Street 1:1801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9024
Practice Address - Country:US
Practice Address - Phone:270-821-0377
Practice Address - Fax:270-821-2395
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist