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General NPI Number Information
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NPI Number | 1467463034
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Entity Type | Organization
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Legal Business Name | JOHN E MCCLELLAN
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 1002 W ARIZONA AVE
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City | PARKER
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State | AZ
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Zip | 85344-5744
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Country | US
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Telephone | 928-669-2147
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Fax | 928-669-5335
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Provider Business Mailing Address
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Address Line | 1002 W ARIZONA AVE
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City | PARKER
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State | AZ
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Zip | 85344-5744
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Country | US
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Telephone | 928-669-2147
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Fax | 928-669-5335
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Authorized Official
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Title or Position | PHARMACIST AND OWNER
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Name | JOHN MCCLELLAN
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Credential | BS
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Telephone | 928-669-2147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y002662
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License Number State | AZ
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