Provider Demographics
NPI:1720365737
Name:TEXLEY, CLARK DELAINE JR (BS PH)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:DELAINE
Last Name:TEXLEY
Suffix:JR
Gender:M
Credentials:BS PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-0348
Mailing Address - Country:US
Mailing Address - Phone:541-995-8459
Mailing Address - Fax:
Practice Address - Street 1:605 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9552
Practice Address - Country:US
Practice Address - Phone:541-995-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist