Provider Demographics
NPI:1487957619
Name:CLODFELTER, ANTHONY (RPH)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:CLODFELTER
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 1:304 MELINDA AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3847
Mailing Address - Country:US
Mailing Address - Phone:704-932-1412
Mailing Address - Fax:704-933-5173
Practice Address - Street 1:520 N CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3802
Practice Address - Country:US
Practice Address - Phone:704-938-3187
Practice Address - Fax:704-933-5173
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist