Provider Demographics
NPI:1861512279
Name:MCLEOD, JAMES DAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAN
Last Name:MCLEOD
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 1:906 N DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MO
Mailing Address - Zip Code:63863-1514
Mailing Address - Country:US
Mailing Address - Phone:573-276-2737
Mailing Address - Fax:573-276-2496
Practice Address - Street 1:906 N DOUGLASS ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1514
Practice Address - Country:US
Practice Address - Phone:573-276-2737
Practice Address - Fax:573-276-2496
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO60096408Medicaid
MO60096408Medicaid