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NPI Code Detail

MEDICARE: MRS. MARY ELLEN MCLAIN PHARMACIST

MEDICARE: MRS. MARY ELLEN MCLAIN PHARMACIST
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
1183500000XPharmacist5302022533MI

General Provider Information

NPI Number : 1558576504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELLEN MCLAIN PHARMACIST
Provider Business Mailing Address
First Line : 16309 EDINBURGH DR
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-2788
Country : US
Telephone Number : 586-286-1291
Fax Number :
Provider Business Practice Location Address
First Line : 26755 BALLARD ST
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-2419
Country : US
Telephone Number : 586-466-5231
Fax Number : 586-466-5344
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2007
Last Update Date : 07/08/2007

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