Provider Demographics
NPI:1528289709
Name:CLANTON, BILLY CLAY JR (RPH)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:CLAY
Last Name:CLANTON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:214 SUMMER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-607-7137
Mailing Address - Fax:
Practice Address - Street 1:6745 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-8747
Practice Address - Country:US
Practice Address - Phone:601-863-2004
Practice Address - Fax:601-863-2016
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09006183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE09006OtherPHARMACY LICENSE