Provider Demographics
NPI:1689957094
Name:CLEMENT, PAULA E (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:E
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9574
Mailing Address - Country:US
Mailing Address - Phone:970-330-4368
Mailing Address - Fax:
Practice Address - Street 1:3700 35TH AVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-9574
Practice Address - Country:US
Practice Address - Phone:970-330-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13363OtherCOLORADO STATE LICENSE NUMBER