Provider Demographics
NPI:1639434459
Name:CLEMONS, MICHAEL AUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:CLEMONS
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 1:1241 S SAN JOSE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3619
Mailing Address - Country:US
Mailing Address - Phone:325-518-2449
Mailing Address - Fax:
Practice Address - Street 1:801 W JOE HARVEY BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0815
Practice Address - Country:US
Practice Address - Phone:575-392-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist