Provider Demographics
NPI:1386927747
Name:HOFFMAN, CLINTON JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:JAMES
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 REDDINGTON TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-5063
Mailing Address - Country:US
Mailing Address - Phone:314-922-4055
Mailing Address - Fax:
Practice Address - Street 1:8000 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5364
Practice Address - Country:US
Practice Address - Phone:314-426-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031047183500000X
SD5385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6039664Medicaid