Provider Demographics
NPI:1164707360
Name:CLEMETSON, RAMA KRISHNA AL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAMA KRISHNA
Middle Name:AL
Last Name:CLEMETSON
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 1:440 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:EL PORTAL
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2150
Mailing Address - Country:US
Mailing Address - Phone:305-418-0518
Mailing Address - Fax:
Practice Address - Street 1:12295 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2713
Practice Address - Country:US
Practice Address - Phone:305-893-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist