Provider Demographics
NPI:1821192055
Name:MCCLELLAN, JOHN KRAMER (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KRAMER
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MAIN ST.
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-0038
Mailing Address - Country:US
Mailing Address - Phone:717-582-2313
Mailing Address - Fax:717-582-4015
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-0038
Practice Address - Country:US
Practice Address - Phone:717-582-2313
Practice Address - Fax:717-582-4015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029568L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist