Provider Demographics
NPI:1710089099
Name:CLEMENT, RICHARD GLENN (R PH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GLENN
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 BLUE SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-8758
Mailing Address - Country:US
Mailing Address - Phone:270-924-1191
Mailing Address - Fax:270-924-1191
Practice Address - Street 1:266 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-0390
Practice Address - Country:US
Practice Address - Phone:270-522-3211
Practice Address - Fax:270-522-5479
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist