Provider Demographics
NPI:1942937115
Name:CLAY, MARTINIQUE LIVINGSTON (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARTINIQUE
Middle Name:LIVINGSTON
Last Name:CLAY
Suffix:
Gender:F
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 1:200 N STATION PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2881
Mailing Address - Country:US
Mailing Address - Phone:801-928-2626
Mailing Address - Fax:801-928-2639
Practice Address - Street 1:200 N STATION PKWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2881
Practice Address - Country:US
Practice Address - Phone:801-928-2626
Practice Address - Fax:801-928-2639
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5166455-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist