Provider Demographics
NPI:1922377282
Name:CLIFTON, CLAYTON W JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:W
Last Name:CLIFTON
Suffix:JR
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 1:6130 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7300
Mailing Address - Country:US
Mailing Address - Phone:601-545-6959
Mailing Address - Fax:601-545-6964
Practice Address - Street 1:6130 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7300
Practice Address - Country:US
Practice Address - Phone:601-545-6959
Practice Address - Fax:601-545-6964
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist