Provider Demographics
NPI:1417433467
Name:MCCLYMONT, JON THEODORE (RPH)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:THEODORE
Last Name:MCCLYMONT
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 1:1599 ALUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2596
Mailing Address - Country:US
Mailing Address - Phone:614-643-5454
Mailing Address - Fax:614-643-5505
Practice Address - Street 1:1599 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2596
Practice Address - Country:US
Practice Address - Phone:614-643-5454
Practice Address - Fax:614-643-5505
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist