Provider Demographics
NPI:1710524418
Name:CLEMMER, JOEL FRANCIS
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:FRANCIS
Last Name:CLEMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2053
Mailing Address - Country:US
Mailing Address - Phone:260-920-2170
Mailing Address - Fax:260-920-2172
Practice Address - Street 1:1005 W 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2053
Practice Address - Country:US
Practice Address - Phone:260-920-2170
Practice Address - Fax:260-920-2172
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist