MEDICARE: MR. IAN MCBRIDE R.PH.

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	03320291	OH

General Provider Information

NPI Number	:	1881984334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IAN MCBRIDE R.PH.

Provider Business Mailing Address
First Line	:	4900 E WEYHE RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-8976
Country	:	US
Telephone Number	:	419-573-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 E PERRY ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1332
Country	:	US
Telephone Number	:	419-734-5583
Fax Number	:	419-734-0853

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

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/18/2011

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