Healthcare Provider Details

I. General information

NPI: 1477836906
Provider Name (Legal Business Name): ROBERT LEE MCCLENDON JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 SARDIS DR
SARDIS CITY AL
35956-2337
US

IV. Provider business mailing address

3195 EAGLEMONT DR
GADSDEN AL
35903-4851
US

V. Phone/Fax

Practice location:
  • Phone: 256-593-8341
  • Fax: 256-893-8347
Mailing address:
  • Phone: 256-494-1427
  • Fax: 256-593-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10306
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: