Provider Demographics
NPI:1962709402
Name:MCLEAN, TINA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5481 HORNS HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9639
Mailing Address - Country:US
Mailing Address - Phone:740-745-5896
Mailing Address - Fax:
Practice Address - Street 1:2940 GROVEPORT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3255
Practice Address - Country:US
Practice Address - Phone:614-491-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-20935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist