Provider Demographics
NPI:1811461494
Name:CLAY, PATRICK GERARD (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:GERARD
Last Name:CLAY
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:PO BOX 470186
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76147-0186
Mailing Address - Country:US
Mailing Address - Phone:816-536-0974
Mailing Address - Fax:817-735-2603
Practice Address - Street 1:3500 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2644
Practice Address - Country:US
Practice Address - Phone:817-735-2798
Practice Address - Fax:817-735-2603
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526761835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy