MEDICARE: MR. SCOTT JOSEPH CLEMENS RPH

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	27868	TX

General Provider Information

NPI Number	:	1952303430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT JOSEPH CLEMENS RPH

Provider Business Mailing Address
First Line	:	PO BOX 270100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-0100
Country	:	US
Telephone Number	:	214-724-2481
Fax Number	:	214-381-1237

Provider Business Practice Location Address
First Line	:	8136 S NORVELL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-5407
Country	:	US
Telephone Number	:	214-724-2481
Fax Number	:	214-381-1237

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	11/03/2012

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