Provider Demographics
NPI:1104812767
Name:CLEM, ALLISON D (RPH)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:D
Last Name:CLEM
Suffix:
Gender:F
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:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-0863
Mailing Address - Country:US
Mailing Address - Phone:479-674-2018
Mailing Address - Fax:
Practice Address - Street 1:2504 MARKET TRCE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8676
Practice Address - Country:US
Practice Address - Phone:479-646-5505
Practice Address - Fax:479-649-7535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist