Provider Demographics
NPI:1336826841
Name:MCCOMAS, JOHN R (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MCCOMAS
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 1:97 PRIVATE DRIVE 3884
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-7974
Mailing Address - Country:US
Mailing Address - Phone:606-922-7269
Mailing Address - Fax:
Practice Address - Street 1:97 PRIVATE DRIVE 3884
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-7974
Practice Address - Country:US
Practice Address - Phone:606-922-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0013806183500000X
KY010541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist