Healthcare Provider Details

I. General information

NPI: 1720850860
Provider Name (Legal Business Name): MAREEA MCCLAIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54391 VILLAGE CENTER DR
IDYLLWILD CA
92549-9997
US

IV. Provider business mailing address

54391 VILLAGE CENTER DR
IDYLLWILD CA
92549-9997
US

V. Phone/Fax

Practice location:
  • Phone: 951-659-2135
  • Fax: 951-659-2226
Mailing address:
  • Phone: 951-659-2135
  • Fax: 951-659-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: