Provider Demographics
NPI:1174951362
Name:ROMAN, CLAYTON RAY (RPH)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:RAY
Last Name:ROMAN
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 1:200 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:TX
Mailing Address - Zip Code:76648-2446
Mailing Address - Country:US
Mailing Address - Phone:254-576-2241
Mailing Address - Fax:
Practice Address - Street 1:200 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:TX
Practice Address - Zip Code:76648-2446
Practice Address - Country:US
Practice Address - Phone:254-576-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist