Provider Demographics
NPI:1538788070
Name:CLEMMONS, ERIN NICOLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 COUNTY ROAD 73
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-5631
Mailing Address - Country:US
Mailing Address - Phone:256-443-6948
Mailing Address - Fax:
Practice Address - Street 1:3351 COUNTY ROAD 73
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-5631
Practice Address - Country:US
Practice Address - Phone:256-443-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0000000000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist