Provider Demographics
NPI:1588190771
Name:MCCLAIN, VALERIE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 BUSH RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:PA
Mailing Address - Zip Code:16124-1205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 BUSH RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:PA
Practice Address - Zip Code:16124-1205
Practice Address - Country:US
Practice Address - Phone:724-456-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist