Provider Demographics
NPI:1437149051
Name:CLELLAND, CARMEN CIRILO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:CIRILO
Last Name:CLELLAND
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 1:333 W MAHONEY ST
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2633
Mailing Address - Country:US
Mailing Address - Phone:928-814-1963
Mailing Address - Fax:
Practice Address - Street 1:333 W MAHONEY ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2633
Practice Address - Country:US
Practice Address - Phone:928-814-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58169183500000X
OK109661835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy