Provider Demographics
NPI:1578207197
Name:MCCLELLAND, KAREN DENISE (CPHT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 LAKESHORE DR APT 38A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1031
Mailing Address - Country:US
Mailing Address - Phone:601-316-1293
Mailing Address - Fax:
Practice Address - Street 1:2144 LAKESHORE DR APT 38A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1031
Practice Address - Country:US
Practice Address - Phone:601-316-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01971183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician