Provider Demographics
NPI:1427207661
Name:DEARMAN, CLYDE NORRIS (PHARMD, AE-C, CDM)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:NORRIS
Last Name:DEARMAN
Suffix:
Gender:M
Credentials:PHARMD, AE-C, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:318-361-0900
Mailing Address - Fax:318-361-2185
Practice Address - Street 1:130 DESIARD ST STE 300
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7363
Practice Address - Country:US
Practice Address - Phone:318-361-0900
Practice Address - Fax:318-361-2185
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA144131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy