Provider Demographics
NPI:1043414287
Name:MCCLELLAN, BARBARA PAULK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:PAULK
Last Name:MCCLELLAN
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 1:17518 NE TERESA TERRACE
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424
Mailing Address - Country:US
Mailing Address - Phone:850-674-8756
Mailing Address - Fax:
Practice Address - Street 1:35 JEFFERSON STREET
Practice Address - Street 2:BUY RITE DRUGS
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324
Practice Address - Country:US
Practice Address - Phone:850-663-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist