Provider Demographics
NPI:1437459328
Name:CLAYBON, KENEKO T (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENEKO
Middle Name:T
Last Name:CLAYBON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 W HARMONY DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TN
Mailing Address - Zip Code:38049-5704
Mailing Address - Country:US
Mailing Address - Phone:901-481-8107
Mailing Address - Fax:901-837-5014
Practice Address - Street 1:11630 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7129
Practice Address - Country:US
Practice Address - Phone:901-837-5011
Practice Address - Fax:901-837-5014
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33753183500000X
ARPD11217183500000X
MSE-010629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist