Provider Demographics
NPI:1336474303
Name:CLEMENS, EVAN CASEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:CASEY
Last Name:CLEMENS
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 1:103 BELLEVUE AVE E APT 504
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5597
Mailing Address - Country:US
Mailing Address - Phone:509-220-7647
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356015
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6015
Practice Address - Country:US
Practice Address - Phone:206-540-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60087316183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist