Provider Demographics
NPI:1669113460
Name:MCCLANAHAN, COREY (RPH)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:MCCLANAHAN
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 1:1010 8TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3357
Mailing Address - Country:US
Mailing Address - Phone:304-543-1023
Mailing Address - Fax:
Practice Address - Street 1:5179 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2003
Practice Address - Country:US
Practice Address - Phone:304-736-3496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist