Provider Demographics
NPI:1679873574
Name:EMERSON, CARLENE L (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:L
Last Name:EMERSON
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 1:430 SE BISHOP BLVD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5503
Mailing Address - Country:US
Mailing Address - Phone:509-334-0819
Mailing Address - Fax:509-334-0847
Practice Address - Street 1:430 SE BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5503
Practice Address - Country:US
Practice Address - Phone:509-334-0819
Practice Address - Fax:509-334-0847
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60007061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist