Provider Demographics
NPI:1144501149
Name:CLEMENTS, ALEXANDRA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 SANDPIPER LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2727
Mailing Address - Country:US
Mailing Address - Phone:912-230-8886
Mailing Address - Fax:
Practice Address - Street 1:6021 S RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4613
Practice Address - Country:US
Practice Address - Phone:407-901-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60231183500000X
GA022070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist