Healthcare Provider Details

I. General information

NPI: 1346302320
Provider Name (Legal Business Name): DARRYL MCCLENDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

PO BOX 35117
LOS ANGELES CA
90035-0117
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-4123
  • Fax: 323-857-3225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number39596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: