Provider Demographics
NPI:1770187460
Name:MCCLEARY, MISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2188
Mailing Address - Country:US
Mailing Address - Phone:220-439-2554
Mailing Address - Fax:
Practice Address - Street 1:609 N WESTOVER BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2188
Practice Address - Country:US
Practice Address - Phone:229-439-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist