Provider Demographics
NPI:1922304864
Name:CLAYTON, GEORGE R (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 PIONEER PKWY E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3935
Mailing Address - Country:US
Mailing Address - Phone:541-747-6627
Mailing Address - Fax:541-747-6629
Practice Address - Street 1:1891 PIONEER PKWY E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3935
Practice Address - Country:US
Practice Address - Phone:541-747-6627
Practice Address - Fax:541-747-6629
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0004600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist