Provider Demographics
NPI:1104265685
Name:STELTE, CLARENCE ELLIS (RPH)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:ELLIS
Last Name:STELTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16225 SIERRA LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1245
Mailing Address - Country:US
Mailing Address - Phone:909-357-2525
Mailing Address - Fax:909-357-3047
Practice Address - Street 1:16225 SIERRA LAKES PKWY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1245
Practice Address - Country:US
Practice Address - Phone:909-357-2525
Practice Address - Fax:909-357-3047
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist