Provider Demographics
NPI:1013304476
Name:MCCLURE, DOUGLAS (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:MCCLURE
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 1:500 S 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9700
Mailing Address - Country:US
Mailing Address - Phone:623-907-4932
Mailing Address - Fax:623-907-4990
Practice Address - Street 1:6710 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-4402
Practice Address - Country:US
Practice Address - Phone:623-934-9243
Practice Address - Fax:623-907-4990
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist