Provider Demographics
NPI:1336409648
Name:CLAYTON, KELLY DRAUGHN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DRAUGHN
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314
Mailing Address - Country:US
Mailing Address - Phone:336-562-5972
Mailing Address - Fax:
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:PROSPECT HILL
Practice Address - State:NC
Practice Address - Zip Code:27314
Practice Address - Country:US
Practice Address - Phone:336-562-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist