Provider Demographics
NPI:1124149679
Name:MCCLUCAS, MARY ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:MCCLUCAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:607 BAUCOM DEESE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8782
Mailing Address - Country:US
Mailing Address - Phone:814-233-9336
Mailing Address - Fax:
Practice Address - Street 1:7735 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3498
Practice Address - Country:US
Practice Address - Phone:704-547-0972
Practice Address - Fax:704-548-8369
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30323183500000X
PARP439281183500000X
PARPI000088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist