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General NPI Number Information
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NPI Number | 1124149679
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Entity Type | Individual
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Provider Name | MARY ANN MCCLUCAS PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 7735 N TRYON ST
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City | CHARLOTTE
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State | NC
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Zip | 28262-3498
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Country | US
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Telephone | 704-547-0972
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Fax | 704-548-8369
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Provider Business Mailing Address
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Address Line | 607 BAUCOM DEESE RD
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City | MONROE
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State | NC
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Zip | 28110-8782
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Country | US
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Telephone | 814-233-9336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 30323
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP439281
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPI000088
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License Number State | PA
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