Provider Demographics
NPI:1689020109
Name:MCCLUNG, REBECCA RAELYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAELYNN
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RAELYNN
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25265-0186
Mailing Address - Country:US
Mailing Address - Phone:304-882-2005
Mailing Address - Fax:304-882-2281
Practice Address - Street 1:307 5TH ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265-4100
Practice Address - Country:US
Practice Address - Phone:304-882-2005
Practice Address - Fax:304-882-2281
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135299183500000X
WV0009413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist