Provider Demographics
NPI:1346904901
Name:CLAYTON, CHRISTIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNN
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:LYNN
Other - Last Name:HERSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8801 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2268
Mailing Address - Country:US
Mailing Address - Phone:972-731-9576
Mailing Address - Fax:
Practice Address - Street 1:4200 BLUE SAGE DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-1310
Practice Address - Country:US
Practice Address - Phone:817-846-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41204OtherLICENSE NUMBER
TX41204Medicaid