Healthcare Provider Details

I. General information

NPI: 1881984334
Provider Name (Legal Business Name): IAN MCBRIDE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 E PERRY ST
PORT CLINTON OH
43452-1332
US

IV. Provider business mailing address

4900 E WEYHE RD
PORT CLINTON OH
43452-8976
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-5583
  • Fax: 419-734-0853
Mailing address:
  • Phone: 419-573-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03320291
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: