MEDICARE: BRENNA K MCCLAIN PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS60166	FL

General Provider Information

NPI Number	:	1043813322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA K MCCLAIN PHARMD

Provider Business Mailing Address
First Line	:	16961 ALICO MISSION WAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4836
Country	:	US
Telephone Number	:	239-433-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	16961 ALICO MISSION WAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4836
Country	:	US
Telephone Number	:	239-433-2110
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ BRENNA K MCCLAIN PHARMD” Practice Location

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