Provider Demographics
NPI:1598847089
Name:CARPENTER, CLEMONT (RPH)
Entity Type:Individual
Prefix:
First Name:CLEMONT
Middle Name:
Last Name:CARPENTER
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 1:1554 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7332
Mailing Address - Country:US
Mailing Address - Phone:334-335-6553
Mailing Address - Fax:334-335-6554
Practice Address - Street 1:1554 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7332
Practice Address - Country:US
Practice Address - Phone:334-335-6553
Practice Address - Fax:334-335-6554
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist