Provider Demographics
NPI:1669756086
Name:CLYMER, BETTY JEAN (RPH)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:CLYMER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2265
Mailing Address - Country:US
Mailing Address - Phone:231-627-5371
Mailing Address - Fax:231-627-6810
Practice Address - Street 1:992 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2265
Practice Address - Country:US
Practice Address - Phone:231-627-5371
Practice Address - Fax:231-627-6810
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist