Provider Demographics
NPI:1922385913
Name:CLEMENT, TERESA SACHIKO-KOENIG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:SACHIKO-KOENIG
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 1:904 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036
Mailing Address - Country:US
Mailing Address - Phone:513-934-1212
Mailing Address - Fax:513-934-1521
Practice Address - Street 1:904 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-934-1212
Practice Address - Fax:513-934-1521
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist