Provider Demographics
NPI:1104970854
Name:CLEMMONS, JEFFREY GLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GLEN
Last Name:CLEMMONS
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 1:296 HAZELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2346
Mailing Address - Country:US
Mailing Address - Phone:256-757-7010
Mailing Address - Fax:256-766-1235
Practice Address - Street 1:3522 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1339
Practice Address - Country:US
Practice Address - Phone:256-766-1235
Practice Address - Fax:256-766-1235
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist