Provider Demographics
NPI:1144332826
Name:NASDAHL, CLIFFORD STEPHEN (PHARMD,BCPP)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:STEPHEN
Last Name:NASDAHL
Suffix:
Gender:M
Credentials:PHARMD,BCPP
Other - Prefix:DR
Other - First Name:CLIFFORD
Other - Middle Name:STEPHEN
Other - Last Name:NASDAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD,BCPP
Mailing Address - Street 1:493 E RACQUET CLUB PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4524
Mailing Address - Country:US
Mailing Address - Phone:901-683-4809
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY/PHARMACY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7429
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH323591835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric