Provider Demographics
NPI:1588051825
Name:CLECKLER, OLIVIA IRONS (MS, RD, LDN,PHARMD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:IRONS
Last Name:CLECKLER
Suffix:
Gender:F
Credentials:MS, RD, LDN,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SADDLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9745
Mailing Address - Country:US
Mailing Address - Phone:601-416-9360
Mailing Address - Fax:
Practice Address - Street 1:5200 SADDLE BROOK RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9745
Practice Address - Country:US
Practice Address - Phone:601-416-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28832183500000X
ARPD12966183500000X
MSE-010564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist