MEDICARE: CHARLES MCCLURE 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	183500000X	Pharmacist	33239113	OH
2	183500000X	Pharmacist	PD14862	AR

General Provider Information

NPI Number	:	1124656517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MCCLURE PHARMD

Provider Business Mailing Address
First Line	:	1580 BLUE ROCK ST UNIT 420
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2745
Country	:	US
Telephone Number	:	479-381-7522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 BLUE ROCK ST UNIT 420
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2745
Country	:	US
Telephone Number	:	479-381-7522
Fax Number	:

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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