Provider Demographics
NPI:1669016846
Name:CLEMENT, MATILDA N (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:N
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 ALEX RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-5836
Mailing Address - Country:US
Mailing Address - Phone:908-386-6788
Mailing Address - Fax:
Practice Address - Street 1:1955 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8383
Practice Address - Country:US
Practice Address - Phone:610-258-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453990183500000X
DEA1-0005311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist