Provider Demographics
NPI:1568693513
Name:CLAYTON, AMANDA REAVES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:REAVES
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 HOLLY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-8681
Mailing Address - Country:US
Mailing Address - Phone:336-364-1021
Mailing Address - Fax:336-599-5076
Practice Address - Street 1:304 N MADISON BLVD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5355
Practice Address - Country:US
Practice Address - Phone:336-599-0234
Practice Address - Fax:336-599-5076
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist