Provider Demographics
NPI:1205808177
Name:CLAIRMONT, MICHAEL J (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CLAIRMONT
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 1:1737 BELMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7804
Mailing Address - Country:US
Mailing Address - Phone:952-855-9590
Mailing Address - Fax:
Practice Address - Street 1:1737 BELMONT AVE NW
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7804
Practice Address - Country:US
Practice Address - Phone:952-855-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2878183500000X
MN119545183500000X
WAPH 60183445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist