Provider Demographics
NPI:1841527876
Name:CLENDENING, BILLY POLE (RPH)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:POLE
Last Name:CLENDENING
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 1:118 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:BRUCEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76630-3210
Mailing Address - Country:US
Mailing Address - Phone:254-744-1095
Mailing Address - Fax:254-751-0812
Practice Address - Street 1:4100 BOSQUE BLVD
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4815
Practice Address - Country:US
Practice Address - Phone:254-751-7215
Practice Address - Fax:254-751-0812
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26916OtherTEXAS PHARMACIST LICENSE