MEDICARE: MR. JAMES DAN MCLEOD 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	28979	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861512279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES DAN MCLEOD R.PH.

Provider Business Mailing Address
First Line	:	906 N DOUGLASS ST
Second Line	:
City	:	MALDEN
State	:	MO
Zip	:	63863-1514
Country	:	US
Telephone Number	:	573-276-2737
Fax Number	:	573-276-2496

Provider Business Practice Location Address
First Line	:	906 N DOUGLASS ST
Second Line	:
City	:	MALDEN
State	:	MO
Zip	:	63863-1514
Country	:	US
Telephone Number	:	573-276-2737
Fax Number	:	573-276-2496

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/09/2007

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