Healthcare Provider Details

I. General information

NPI: 1194610170
Provider Name (Legal Business Name): KAIYA MARIE CLEMENTS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 S ELM ST
JENKS OK
74037-3002
US

IV. Provider business mailing address

6535 E 90TH ST
TULSA OK
74133-5027
US

V. Phone/Fax

Practice location:
  • Phone: 918-209-7016
  • Fax:
Mailing address:
  • Phone: 918-752-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20938
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: