Healthcare Provider Details

I. General information

NPI: 1598216004
Provider Name (Legal Business Name): MCCLURES COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LIMESTONE TER STE A1
JARRELL TX
76537-1293
US

IV. Provider business mailing address

305 LIMESTONE TER STE A1
JARRELL TX
76537-1293
US

V. Phone/Fax

Practice location:
  • Phone: 512-598-3767
  • Fax: 512-598-3769
Mailing address:
  • Phone: 512-598-3767
  • Fax: 512-598-3769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: NADJA BROWN
Title or Position: PIC
Credential:
Phone: 979-820-0377