Provider Demographics
NPI:1073894507
Name:MCCLENDON, JANA LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LEE
Last Name:MCCLENDON
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 1:4581 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8108
Mailing Address - Country:US
Mailing Address - Phone:770-650-5008
Mailing Address - Fax:
Practice Address - Street 1:2988 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3033
Practice Address - Country:US
Practice Address - Phone:678-560-1871
Practice Address - Fax:678-560-1876
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist