Provider Demographics
NPI:1124507512
Name:CLEGG, EMMA JANE (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:JANE
Last Name:CLEGG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:JANE
Other - Last Name:LUMPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9310 SOUTHPARK CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8634
Mailing Address - Country:US
Mailing Address - Phone:407-845-6774
Mailing Address - Fax:
Practice Address - Street 1:9310 SOUTHPARK CENTER LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8634
Practice Address - Country:US
Practice Address - Phone:407-845-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist