Provider Demographics
NPI:1437735842
Name:CLANTON, DOVIE (CPHT)
Entity Type:Individual
Prefix:
First Name:DOVIE
Middle Name:
Last Name:CLANTON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-7427
Mailing Address - Country:US
Mailing Address - Phone:205-471-8251
Mailing Address - Fax:
Practice Address - Street 1:890 ODUM RD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-4652
Practice Address - Country:US
Practice Address - Phone:205-631-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT47921183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician