Provider Demographics
NPI:1578898581
Name:CLAY, REBECCA DIANNE (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANNE
Last Name:CLAY
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 1:338 TAMARIND DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-9711
Mailing Address - Country:US
Mailing Address - Phone:704-982-2301
Mailing Address - Fax:704-982-2315
Practice Address - Street 1:840 NC HWY 24/27 E
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-982-2301
Practice Address - Fax:704-982-2315
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist