Provider Demographics
NPI:1124656517
Name:MCCLURE, CHARLES (PHARMD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 BLUE ROCK ST UNIT 420
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2745
Mailing Address - Country:US
Mailing Address - Phone:479-381-7522
Mailing Address - Fax:
Practice Address - Street 1:1580 BLUE ROCK ST UNIT 420
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-2745
Practice Address - Country:US
Practice Address - Phone:479-381-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33239113183500000X
ARPD14862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist