Provider Demographics
NPI:1699579375
Name:MCCLELLAND, MADISON SHAE (PHARMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SHAE
Last Name:MCCLELLAND
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E STATE HIGHWAY 152
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4406
Mailing Address - Country:US
Mailing Address - Phone:405-256-0555
Mailing Address - Fax:405-256-0565
Practice Address - Street 1:103 E STATE HIGHWAY 152
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4406
Practice Address - Country:US
Practice Address - Phone:405-256-0555
Practice Address - Fax:405-256-0565
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist