Provider Demographics
NPI:1487071189
Name:CLEMENT, CASSANDRA (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 EAST BENGAL BOULEVARD
Mailing Address - Street 2:APT M102
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:815-735-5232
Mailing Address - Fax:
Practice Address - Street 1:2100 E BENGAL BLVD
Practice Address - Street 2:APT M102
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-7135
Practice Address - Country:US
Practice Address - Phone:815-735-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist