Provider Demographics
NPI:1033786652
Name:MACLELLAN, JANE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:MACLELLAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9562
Mailing Address - Country:US
Mailing Address - Phone:573-239-0078
Mailing Address - Fax:
Practice Address - Street 1:700 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4373
Practice Address - Country:US
Practice Address - Phone:573-442-0194
Practice Address - Fax:573-443-8253
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004031566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist