Provider Demographics
NPI:1053643494
Name:CLEMENTE, IRIS ELIZABETH (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:ELIZABETH
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17431 SW 119TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2217
Mailing Address - Country:US
Mailing Address - Phone:305-969-0147
Mailing Address - Fax:
Practice Address - Street 1:11478 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6575
Practice Address - Country:US
Practice Address - Phone:305-971-3388
Practice Address - Fax:305-971-3306
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT21115183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician