Provider Demographics
NPI:1427005297
Name:ROTH MCCLURG, MARY T (PHARMD, MHS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:ROTH MCCLURG
Suffix:
Gender:F
Credentials:PHARMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50303 GOVERNORS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8845
Mailing Address - Country:US
Mailing Address - Phone:919-843-8083
Mailing Address - Fax:919-966-8486
Practice Address - Street 1:CAMPUS BOX 7360, KERR HALL, SCHOOL OF PHARMACY
Practice Address - Street 2:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-8083
Practice Address - Fax:919-966-8486
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist