Provider Demographics
NPI:1770227779
Name:PHARR, CLENDON W
Entity Type:Individual
Prefix:MR
First Name:CLENDON
Middle Name:W
Last Name:PHARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 HALEY DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-4904
Mailing Address - Country:US
Mailing Address - Phone:251-591-0533
Mailing Address - Fax:251-650-1624
Practice Address - Street 1:6784 HALEY DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-4904
Practice Address - Country:US
Practice Address - Phone:251-591-0533
Practice Address - Fax:251-650-1624
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6055511343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)