Provider Demographics
NPI:1295390250
Name:MCCLAIN, RAYNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-9783
Mailing Address - Country:US
Mailing Address - Phone:610-704-3390
Mailing Address - Fax:
Practice Address - Street 1:450 BLUE VALLEY DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1525
Practice Address - Country:US
Practice Address - Phone:610-863-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP0452099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183500000XOtherPHARMACIST