Provider Demographics
NPI:1629270285
Name:STIMSON, BERTON CLAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BERTON
Middle Name:CLAY
Last Name:STIMSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5031
Mailing Address - Country:US
Mailing Address - Phone:931-552-0264
Mailing Address - Fax:
Practice Address - Street 1:3050 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5031
Practice Address - Country:US
Practice Address - Phone:931-552-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist