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General NPI Number Information
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NPI Number | 1346519592
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Entity Type | Individual
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Provider Name | MARY ALICE MCLEOD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 7700 NE AMBASSADOR PL UNIT 103
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City | PORTLAND
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State | OR
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Zip | 97220-1394
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Country | US
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Telephone | 971-230-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 4249 SUSSEX ST
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City | WEST LINN
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State | OR
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Zip | 97068-3725
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Country | US
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Telephone | 971-230-0555
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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 | PS40669
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH-0014013
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License Number State | OR
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