Provider Demographics
NPI:1144872508
Name:KLEMENTI, JIMI MARK (RPH)
Entity type:Individual
Prefix:
First Name:JIMI
Middle Name:MARK
Last Name:KLEMENTI
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 1:701 S STEMMONS FWY STE 230
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4519
Mailing Address - Country:US
Mailing Address - Phone:469-771-3151
Mailing Address - Fax:
Practice Address - Street 1:701 S STEMMONS FWY STE 230
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4519
Practice Address - Country:US
Practice Address - Phone:469-771-3151
Practice Address - Fax:469-771-3152
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist