Provider Demographics
NPI:1073632535
Name:MCCLOUD, TARA BETH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BETH
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 WOODCREST RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1933
Mailing Address - Country:US
Mailing Address - Phone:606-475-1016
Mailing Address - Fax:606-474-0648
Practice Address - Street 1:12544 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9687
Practice Address - Country:US
Practice Address - Phone:606-475-0232
Practice Address - Fax:606-475-0254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY012986OtherPHARMACIST ID