Provider Demographics
NPI:1326383522
Name:MCCLENDON, EDWARD VINSON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VINSON
Last Name:MCCLENDON
Suffix:
Gender:M
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 1:114 WOODEL CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7336
Mailing Address - Country:US
Mailing Address - Phone:256-837-1087
Mailing Address - Fax:
Practice Address - Street 1:114 WOODEL CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7336
Practice Address - Country:US
Practice Address - Phone:256-837-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist