Provider Demographics
NPI:1558098210
Name:CLAYTON, VAN ALLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:ALLEN
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-8552
Mailing Address - Country:US
Mailing Address - Phone:870-637-2162
Mailing Address - Fax:870-886-9200
Practice Address - Street 1:1208 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1005
Practice Address - Country:US
Practice Address - Phone:870-886-8100
Practice Address - Fax:870-886-9200
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD08346OtherSTATE LICENSE NUMBER