Provider Demographics
NPI:1417087149
Name:MCCLAIN, JOHN TODD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TODD
Last Name:MCCLAIN
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 1:18473 WIGEON TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7150
Mailing Address - Country:US
Mailing Address - Phone:979-690-9737
Mailing Address - Fax:
Practice Address - Street 1:1110 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2626
Practice Address - Country:US
Practice Address - Phone:979-691-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist