Provider Demographics
NPI:1639834997
Name:AUTRY, CLAYTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:AUTRY
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 1:73 MERGANSER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2155
Mailing Address - Country:US
Mailing Address - Phone:207-331-7509
Mailing Address - Fax:
Practice Address - Street 1:500 GALLERY BLVD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-6606
Practice Address - Country:US
Practice Address - Phone:207-885-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist