Provider Demographics
NPI:1467590943
Name:CLAYTON, RONALD HARRIS
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:HARRIS
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4525
Mailing Address - Country:US
Mailing Address - Phone:850-932-6201
Mailing Address - Fax:
Practice Address - Street 1:3327 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3351
Practice Address - Country:US
Practice Address - Phone:850-932-3581
Practice Address - Fax:850-932-8137
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0013456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist