Provider Demographics
NPI:1225669864
Name:KLEMENTICH, SANDRA LYNN (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:KLEMENTICH
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 1:4218 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-6603
Mailing Address - Country:US
Mailing Address - Phone:281-229-2247
Mailing Address - Fax:
Practice Address - Street 1:16400 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5721
Practice Address - Country:US
Practice Address - Phone:281-286-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist