Provider Demographics
NPI:1467637785
Name:CLEMENT, CANDICE J (RPH, ESQ)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:J
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:RPH, ESQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1503
Mailing Address - Country:US
Mailing Address - Phone:315-331-2181
Mailing Address - Fax:315-331-3104
Practice Address - Street 1:135 E UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1503
Practice Address - Country:US
Practice Address - Phone:315-331-2181
Practice Address - Fax:315-331-3104
Is Sole Proprietor?:No
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist