Provider Demographics
NPI:1255614368
Name:MCLAIN, MONA (PHARMD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MCLAIN
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 1:1301 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9307
Mailing Address - Country:US
Mailing Address - Phone:231-348-7510
Mailing Address - Fax:231-348-7596
Practice Address - Street 1:1301 N US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9307
Practice Address - Country:US
Practice Address - Phone:231-348-7510
Practice Address - Fax:231-348-7596
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist