Provider Demographics
NPI:1912176504
Name:MCCLELLAN, DAVID C (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:MCCLELLAN
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 1:553 LONGLEAF RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3348
Mailing Address - Country:US
Mailing Address - Phone:757-486-6037
Mailing Address - Fax:
Practice Address - Street 1:553 LONGLEAF RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3348
Practice Address - Country:US
Practice Address - Phone:757-486-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist