Provider Demographics
NPI:1487275707
Name:MCCLANAHAN, STEPHEN L II (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:MCCLANAHAN
Suffix:II
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 1:1173 E HINES ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1277
Mailing Address - Country:US
Mailing Address - Phone:417-735-0055
Mailing Address - Fax:
Practice Address - Street 1:1173 E HINES ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1277
Practice Address - Country:US
Practice Address - Phone:417-735-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist