Provider Demographics
NPI:1467889709
Name:MCCLOUD, KENNETH S (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:S
Last Name:MCCLOUD
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 1:1828 CALISTOGA CT
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-7527
Mailing Address - Country:US
Mailing Address - Phone:541-485-0427
Mailing Address - Fax:541-485-1484
Practice Address - Street 1:1675 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3814
Practice Address - Country:US
Practice Address - Phone:541-485-0427
Practice Address - Fax:541-485-1484
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist