Provider Demographics
NPI:1598216004
Name:MCCLURES COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:MCCLURES COMPOUNDING PHARMACY
Other - Org Name:JARRELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:NADJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-820-0377
Mailing Address - Street 1:305 LIMESTONE TER STE A1
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-1293
Mailing Address - Country:US
Mailing Address - Phone:512-598-3767
Mailing Address - Fax:512-598-3769
Practice Address - Street 1:305 LIMESTONE TER STE A1
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-1293
Practice Address - Country:US
Practice Address - Phone:512-598-3767
Practice Address - Fax:512-598-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165837OtherPK