Provider Demographics
NPI:1275752446
Name:GRACE, CLAYTON JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JAMES
Last Name:GRACE
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 1:1410 N 780 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2319
Mailing Address - Country:US
Mailing Address - Phone:801-768-2002
Mailing Address - Fax:
Practice Address - Street 1:76 N 1100 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2952
Practice Address - Country:US
Practice Address - Phone:801-756-4021
Practice Address - Fax:801-756-1181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349338-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT349338-8911OtherPHARMACIST CONTROLLED SUB
UT349338-1701OtherPHARMACIST