Healthcare Provider Details

I. General information

NPI: 1376669184
Provider Name (Legal Business Name): CLEMSON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MCMILLAN RD CLEMSON UNIVERSITY
CLEMSON SC
29634-0001
US

IV. Provider business mailing address

PO BOX 344054 CLEMSON UNIVERSITY
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-3562
  • Fax: 864-656-2500
Mailing address:
  • Phone: 864-656-3562
  • Fax: 864-656-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1715
License Number StateSC

VIII. Authorized Official

Name: LESSLIE PEKAREK
Title or Position: AVP OF STUDENT HEALTH AND WELLNESS
Credential: MD
Phone: 864-656-3565