Provider Demographics
NPI:1295454254
Name:MCCLURE, CAROLYN VIRGINIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:VIRGINIA
Last Name:MCCLURE
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:CMR 415 BOX 6442
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0065
Mailing Address - Country:US
Mailing Address - Phone:703-692-1224
Mailing Address - Fax:
Practice Address - Street 1:BLDG 475
Practice Address - Street 2:ROOM 301
Practice Address - City:GRAFENWOHR
Practice Address - State:GERMANY
Practice Address - Zip Code:92655
Practice Address - Country:DE
Practice Address - Phone:601-590-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist