Provider Demographics
NPI:1013546795
Name:MCCLANAHAN, ROY III
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:MCCLANAHAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CARRICK LOOP
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-9019
Mailing Address - Country:US
Mailing Address - Phone:304-549-1244
Mailing Address - Fax:
Practice Address - Street 1:707 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4824
Practice Address - Country:US
Practice Address - Phone:843-248-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist