Provider Demographics
NPI:1356461396
Name:MCCLELLAN, CHRIS BRENT (RPH)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:BRENT
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 S 400 E
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8116
Mailing Address - Country:US
Mailing Address - Phone:801-654-3405
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N STE 1
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1668
Practice Address - Country:US
Practice Address - Phone:801-465-4498
Practice Address - Fax:801-465-0948
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333839-17011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy