MEDICARE: DOUGLAS MCCLURE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S014143	AZ

General Provider Information

NPI Number	:	1013304476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS MCCLURE RPH

Provider Business Mailing Address
First Line	:	500 S 99TH AVE
Second Line	:
City	:	TOLLESON
State	:	AZ
Zip	:	85353-9700
Country	:	US
Telephone Number	:	623-907-4932
Fax Number	:	623-907-4990

Provider Business Practice Location Address
First Line	:	6710 W BETHANY HOME RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4402
Country	:	US
Telephone Number	:	623-934-9243
Fax Number	:	623-907-4990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/23/2015

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