Provider Demographics
NPI:1063749935
Name:MCCLURE, CHARLES LESLIE (BS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LESLIE
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16211 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1707
Mailing Address - Country:US
Mailing Address - Phone:281-213-3675
Mailing Address - Fax:281-213-3597
Practice Address - Street 1:16211 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1707
Practice Address - Country:US
Practice Address - Phone:281-213-3675
Practice Address - Fax:281-213-3597
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist