Provider Demographics
NPI:1700858271
Name:CLAY, DERRIK RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DERRIK
Middle Name:RICHARD
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 1:7568 MALOYA LN SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9083
Mailing Address - Country:US
Mailing Address - Phone:360-475-5035
Mailing Address - Fax:360-475-4786
Practice Address - Street 1:NAVAL HOSPITAL CODE 053
Practice Address - Street 2:HP-01 BOONE RD
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1898
Practice Address - Country:US
Practice Address - Phone:360-475-5035
Practice Address - Fax:360-475-4786
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist