Provider Demographics
NPI:1952303430
Name:CLEMENS, SCOTT JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:CLEMENS
Suffix:
Gender:M
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:PO BOX 270100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-0100
Mailing Address - Country:US
Mailing Address - Phone:214-724-2481
Mailing Address - Fax:214-381-1237
Practice Address - Street 1:8136 S NORVELL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-5407
Practice Address - Country:US
Practice Address - Phone:214-724-2481
Practice Address - Fax:214-381-1237
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4467340001Medicare ID - Type Unspecified