Provider Demographics
NPI:1801419882
Name:CLEMENTS-MAIDEN, RACHAEL D (RPH)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:D
Last Name:CLEMENTS-MAIDEN
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 1:12778 N 1225 W
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-4740
Mailing Address - Country:US
Mailing Address - Phone:574-581-1972
Mailing Address - Fax:
Practice Address - Street 1:1088 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1816
Practice Address - Country:US
Practice Address - Phone:574-583-3250
Practice Address - Fax:574-583-5438
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018927A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist