Provider Demographics
NPI:1639134083
Name:CLEMENTS, DAVID E SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:CLEMENTS
Suffix:SR
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 1:315 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-227-6338
Mailing Address - Fax:770-229-2571
Practice Address - Street 1:DAVIDS DRUG & SURGICAL SHOP
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-227-6338
Practice Address - Fax:770-229-2571
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist