=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710188677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREG LEE MCCLANAHAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 N MAIN ST
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24354-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-783-4115
-----------------------------------------------------
Fax | 276-483-1411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27500 OSCEOLA RD
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24211-6460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-676-0937
-----------------------------------------------------
Fax | 276-783-4115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202009416
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------