Provider Demographics
NPI:1912507583
Name:THOMPSON, CLAYTON EARL (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:EARL
Last Name:THOMPSON
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 1:500 W MOUNT VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1920
Mailing Address - Country:US
Mailing Address - Phone:417-461-7028
Mailing Address - Fax:417-461-7032
Practice Address - Street 1:500 W MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1920
Practice Address - Country:US
Practice Address - Phone:417-461-7028
Practice Address - Fax:417-461-7032
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist