Provider Demographics
NPI:1467713909
Name:CLOUSER, EDWARD MARSHALL (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MARSHALL
Last Name:CLOUSER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:MARSHALL
Other - Last Name:CLOUSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-6777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORMANGEE
Practice Address - State:TX
Practice Address - Zip Code:77871-6777
Practice Address - Country:US
Practice Address - Phone:936-348-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist