Provider Demographics
NPI:1528460706
Name:CLEMENTE, ESTELA UY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ESTELA
Middle Name:UY
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16420 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:STE 103 BOX 194
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:813-731-0433
Mailing Address - Fax:
Practice Address - Street 1:16420 SE MCGILLIVRAY BLVD
Practice Address - Street 2:STE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:813-731-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60658900183500000X
ARPD13317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist