Provider Demographics
NPI:1811245046
Name:PRICE, MARK CLAYTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLAYTON
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 PUETTS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-8734
Mailing Address - Country:US
Mailing Address - Phone:276-782-0046
Mailing Address - Fax:
Practice Address - Street 1:500 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-2812
Practice Address - Country:US
Practice Address - Phone:704-435-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist