Provider Demographics
NPI:1396022679
Name:CLOTHIER, PHILLIP CRAIG (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CRAIG
Last Name:CLOTHIER
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 1:346 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3906
Mailing Address - Country:US
Mailing Address - Phone:870-733-0138
Mailing Address - Fax:870-733-0237
Practice Address - Street 1:346 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3906
Practice Address - Country:US
Practice Address - Phone:870-733-0138
Practice Address - Fax:870-733-0237
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19596OtherPHARMACIST