Provider Demographics
NPI:1659951432
Name:CLAY, DYLAN JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:CLAY
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 1:4640 GALEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2722
Mailing Address - Country:US
Mailing Address - Phone:409-782-2809
Mailing Address - Fax:
Practice Address - Street 1:3890 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2247
Practice Address - Country:US
Practice Address - Phone:409-832-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist