Provider Demographics
NPI:1710275193
Name:CLEMENT, WM. B SR (DPH)
Entity Type:Individual
Prefix:MR
First Name:WM.
Middle Name:B
Last Name:CLEMENT
Suffix:SR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 286
Mailing Address - Street 2:10033 HWY 70-E
Mailing Address - City:MCEWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101
Mailing Address - Country:US
Mailing Address - Phone:931-582-8808
Mailing Address - Fax:931-582-7707
Practice Address - Street 1:10033 HWY 70-E
Practice Address - Street 2:
Practice Address - City:MCEWEN
Practice Address - State:TN
Practice Address - Zip Code:37101
Practice Address - Country:US
Practice Address - Phone:931-582-8808
Practice Address - Fax:931-582-7707
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist