Provider Demographics
NPI:1336459189
Name:ANSLEY, CLARENCE WAYNE II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:WAYNE
Last Name:ANSLEY
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:99 EGLIN PARKWAY NW
Mailing Address - Street 2:
Mailing Address - City:FT WALTON
Mailing Address - State:FL
Mailing Address - Zip Code:32548-0000
Mailing Address - Country:US
Mailing Address - Phone:850-244-1226
Mailing Address - Fax:850-244-8418
Practice Address - Street 1:99 EGLIN PARKWAY NW
Practice Address - Street 2:
Practice Address - City:FT WALTON
Practice Address - State:FL
Practice Address - Zip Code:32548-0000
Practice Address - Country:US
Practice Address - Phone:850-244-1226
Practice Address - Fax:850-244-8418
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 37524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist