Healthcare Provider Details

I. General information

NPI: 1902518277
Provider Name (Legal Business Name): RUSHAWN MCLEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E FORDHAM RD
BRONX NY
10458-5010
US

IV. Provider business mailing address

406 E FORDHAM RD
BRONX NY
10458-5010
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-2461
  • Fax:
Mailing address:
  • Phone: 718-220-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: