Provider Demographics
NPI:1639499916
Name:CHILDRESS, BILLY-CLYDE (PHARMD, MBA, MOL)
Entity Type:Individual
Prefix:DR
First Name:BILLY-CLYDE
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:PHARMD, MBA, MOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PLEASANT VALLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9774
Mailing Address - Country:US
Mailing Address - Phone:270-417-6701
Mailing Address - Fax:
Practice Address - Street 1:1301 PLEASANT VALLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0145731835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care