Provider Demographics
NPI:1770866279
Name:BIRDSELL, CLAYTON ANDREW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:ANDREW
Last Name:BIRDSELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6404
Mailing Address - Country:US
Mailing Address - Phone:501-623-1998
Mailing Address - Fax:501-623-4903
Practice Address - Street 1:3631 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6404
Practice Address - Country:US
Practice Address - Phone:501-623-1998
Practice Address - Fax:501-623-4903
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist