Provider Demographics
NPI:1972101053
Name:CLEMENTS, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-3120
Mailing Address - Country:US
Mailing Address - Phone:574-295-4333
Mailing Address - Fax:574-522-6265
Practice Address - Street 1:100 N ELKHART ST
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573
Practice Address - Country:US
Practice Address - Phone:574-862-1454
Practice Address - Fax:574-862-4923
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021908A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist