Provider Demographics
NPI:1114393766
Name:MCCLELLAND, ROBERT JR (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCCLELLAND
Suffix:JR
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 2ND AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1789
Mailing Address - Country:US
Mailing Address - Phone:270-780-2650
Mailing Address - Fax:
Practice Address - Street 1:825 2ND AVE STE A1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1789
Practice Address - Country:US
Practice Address - Phone:270-780-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist