Provider Demographics
NPI:1376856443
Name:MCCLAIN, KATHY L (DPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7994 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1909
Mailing Address - Country:US
Mailing Address - Phone:901-873-3373
Mailing Address - Fax:
Practice Address - Street 1:7994 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1909
Practice Address - Country:US
Practice Address - Phone:901-873-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist