Provider Demographics
NPI:1477832103
Name:MCLEAN, PAMELA ANN (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5235
Mailing Address - Country:US
Mailing Address - Phone:607-273-3647
Mailing Address - Fax:
Practice Address - Street 1:625 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5235
Practice Address - Country:US
Practice Address - Phone:607-273-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist