MEDICARE: DR. MONIQUE KISANDRA MCLEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202215320	VA

General Provider Information

NPI Number	:	1427505775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE KISANDRA MCLEAN

Provider Business Mailing Address
First Line	:	5315 HENNEMAN DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 HENNEMAN DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2401
Country	:	US
Telephone Number	:	757-852-2860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2016
Last Update Date	:	09/03/2016

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