Provider Demographics
NPI:1235650342
Name:CLEMENT, TERRELL DAVIS (RPH)
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:DAVIS
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 ARKADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7718
Mailing Address - Country:US
Mailing Address - Phone:205-275-0047
Mailing Address - Fax:
Practice Address - Street 1:1801 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4037
Practice Address - Country:US
Practice Address - Phone:205-221-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist