Provider Demographics
NPI:1275576399
Name:MCCLUNG, SUSAN LOUISE (DPH, CPED)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:DPH, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NW SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6304
Mailing Address - Country:US
Mailing Address - Phone:580-248-7360
Mailing Address - Fax:580-248-7589
Practice Address - Street 1:12 NW SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6304
Practice Address - Country:US
Practice Address - Phone:580-248-7360
Practice Address - Fax:580-248-7589
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist