Provider Demographics
NPI:1811271570
Name:CLAYBAKER, CLINTON W (RPH)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:W
Last Name:CLAYBAKER
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 1:2951 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3632
Mailing Address - Country:US
Mailing Address - Phone:417-890-7924
Mailing Address - Fax:417-883-4910
Practice Address - Street 1:2951 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OK
Practice Address - Zip Code:65701
Practice Address - Country:US
Practice Address - Phone:417-890-7924
Practice Address - Fax:417-883-4910
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO027583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist