Provider Demographics
NPI:1720647985
Name:MCCLURE, SARAH REBECCA (RPH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:MCCLURE
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 1:6006 TRINITY HTS
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8318
Mailing Address - Country:US
Mailing Address - Phone:870-773-6382
Mailing Address - Fax:
Practice Address - Street 1:100 EAST ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6304
Practice Address - Country:US
Practice Address - Phone:870-773-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist