Provider Demographics
NPI:1639155310
Name:MCCLAIN, JAMES ANTHONY (R PH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5541 RIVERVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2443
Mailing Address - Country:US
Mailing Address - Phone:314-381-4566
Mailing Address - Fax:314-382-0263
Practice Address - Street 1:5541 RIVERVIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120-2443
Practice Address - Country:US
Practice Address - Phone:314-381-4566
Practice Address - Fax:314-367-7010
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2636314OtherNCPDP