MEDICARE: MR. WM. B. CLEMENT SR. DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	178	TN

General Provider Information

NPI Number	:	1710275193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WM. B. CLEMENT SR. DPH

Provider Business Mailing Address
First Line	:	P.O. BOX 286
Second Line	:	10033 HWY 70-E
City	:	MCEWEN
State	:	TN
Zip	:	37101
Country	:	US
Telephone Number	:	931-582-8808
Fax Number	:	931-582-7707

Provider Business Practice Location Address
First Line	:	10033 HWY 70-E
Second Line	:
City	:	MCEWEN
State	:	TN
Zip	:	37101
Country	:	US
Telephone Number	:	931-582-8808
Fax Number	:	931-582-7707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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