MEDICARE: MR. RAYMOND MCCLURE II 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	22355	TX

General Provider Information

NPI Number	:	1760883532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND MCCLURE II R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 50745
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76206-0745
Country	:	US
Telephone Number	:	940-383-1240
Fax Number	:	940-383-2321

Provider Business Practice Location Address
First Line	:	2800 SHORELINE DR
Second Line	:	SUITE 120
City	:	DENTON
State	:	TX
Zip	:	76210-0128
Country	:	US
Telephone Number	:	940-383-1240
Fax Number	:	940-383-2321

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

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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