Provider Demographics
NPI:1790385425
Name:SUBLETTE, CLINTON F (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:F
Last Name:SUBLETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:653 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7715
Mailing Address - Country:US
Mailing Address - Phone:636-349-3007
Mailing Address - Fax:636-349-1986
Practice Address - Street 1:653 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7715
Practice Address - Country:US
Practice Address - Phone:636-349-3007
Practice Address - Fax:636-349-1986
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist