Provider Demographics
NPI:1447690359
Name:CLEMENT, MEGAN MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MAE
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MAE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:W158S7646 QUIETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8393
Mailing Address - Country:US
Mailing Address - Phone:847-373-9024
Mailing Address - Fax:
Practice Address - Street 1:2985 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3133
Practice Address - Country:US
Practice Address - Phone:414-762-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17017-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist