Provider Demographics
NPI:1194870204
Name:MCEWEN, CLEM FENN
Entity type:Individual
Prefix:
First Name:CLEM
Middle Name:FENN
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 E 3770 S
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6215
Mailing Address - Country:US
Mailing Address - Phone:435-628-2545
Mailing Address - Fax:
Practice Address - Street 1:538 N 1300 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3222
Practice Address - Country:US
Practice Address - Phone:435-673-9204
Practice Address - Fax:435-628-2865
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1437341701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist