Provider Demographics
NPI:1144496530
Name:WAHLSMITH, CLAY (RPH)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:
Last Name:WAHLSMITH
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 1:1183 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8750
Mailing Address - Country:US
Mailing Address - Phone:859-745-0551
Mailing Address - Fax:
Practice Address - Street 1:10 WINCHESTER PLZ
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1143
Practice Address - Country:US
Practice Address - Phone:859-744-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012107183500000X
IL051-288078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist