Provider Demographics
NPI:1265178560
Name:MCCLUNG, ANGELA (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14479 IRON HORSE WAY
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3971
Mailing Address - Country:US
Mailing Address - Phone:904-608-2471
Mailing Address - Fax:
Practice Address - Street 1:3326 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3870
Practice Address - Country:US
Practice Address - Phone:210-732-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58469183500000X
TXTX58469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist