Provider Demographics
NPI:1073060216
Name:CLEMENS, CRAIG L
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W MARKET ST STE P
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1017
Mailing Address - Country:US
Mailing Address - Phone:330-306-9008
Mailing Address - Fax:
Practice Address - Street 1:103 W MARKET ST STE P
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1017
Practice Address - Country:US
Practice Address - Phone:330-306-3008
Practice Address - Fax:330-306-3880
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03313316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist