Provider Demographics
NPI:1285912899
Name:MCLAUGHLIN, DERBY JOHN (R PH)
Entity type:Individual
Prefix:MR
First Name:DERBY
Middle Name:JOHN
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BARSCAPE LN
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-8525
Mailing Address - Country:US
Mailing Address - Phone:707-476-8870
Mailing Address - Fax:
Practice Address - Street 1:85 BARSCAPE LN
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-8525
Practice Address - Country:US
Practice Address - Phone:707-476-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist