MEDICARE: MR. JAMES ANTHONY MCCLAIN R PH

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	028915	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2636314	OTHER	MO	NCPDP

General Provider Information

NPI Number	:	1639155310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ANTHONY MCCLAIN R PH

Provider Business Mailing Address
First Line	:	5541 RIVERVIEW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2443
Country	:	US
Telephone Number	:	314-381-4566
Fax Number	:	314-382-0263

Provider Business Practice Location Address
First Line	:	5541 RIVERVIEW BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2443
Country	:	US
Telephone Number	:	314-381-4566
Fax Number	:	314-367-7010

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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