Provider Demographics
NPI:1992341994
Name:CLAWSON, CONNIE SUE (RPH)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 SAGAMORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1446
Mailing Address - Country:US
Mailing Address - Phone:765-464-1456
Mailing Address - Fax:
Practice Address - Street 1:1032 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1446
Practice Address - Country:US
Practice Address - Phone:765-464-1456
Practice Address - Fax:765-464-8247
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016311A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist