Healthcare Provider Details

I. General information

NPI: 1598847089
Provider Name (Legal Business Name): CLEMONT CARPENTER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 S FOREST AVE
LUVERNE AL
36049-7332
US

IV. Provider business mailing address

1554 S FOREST AVE
LUVERNE AL
36049-7332
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-6553
  • Fax: 334-335-6554
Mailing address:
  • Phone: 334-335-6553
  • Fax: 334-335-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4775
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: