Provider Demographics
NPI:1942221916
Name:CLEMENS MARKET INC
Entity Type:Organization
Organization Name:CLEMENS MARKET INC
Other - Org Name:CLEMENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-361-9000
Mailing Address - Street 1:616 E MAIN ST
Mailing Address - Street 2:HILLCREST SHOPPING CENTER
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 E MAIN ST
Practice Address - Street 2:HILLCREST SHOPPING CENTER
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2964
Practice Address - Country:US
Practice Address - Phone:215-855-0734
Practice Address - Fax:215-855-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4811103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007768230005Medicaid
3980085OtherOTHER ID NUMBER-COMMERCIAL NUMBER