Provider Demographics
NPI:1568962983
Name:KILGORE, CLAYTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:KILGORE
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 1:208 SUNCREST ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3494
Mailing Address - Country:US
Mailing Address - Phone:423-477-3847
Mailing Address - Fax:423-477-4392
Practice Address - Street 1:208 SUNCREST ST UNIT 1
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615
Practice Address - Country:US
Practice Address - Phone:423-477-3847
Practice Address - Fax:423-477-4392
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist