Provider Demographics
NPI:1265792451
Name:ENG, CLAYTON (RPH)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:ENG
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 1:5325 LAKEMONT BLVD SE APT 1444
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5580
Mailing Address - Country:US
Mailing Address - Phone:914-843-8446
Mailing Address - Fax:
Practice Address - Street 1:5325 LAKEMONT BLVD SE APT 1444
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5580
Practice Address - Country:US
Practice Address - Phone:914-843-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60104244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist