Provider Demographics
NPI:1972387082
Name:MCCLURE, NATHANIEL PAUL (CPHT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:PAUL
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CURWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16833-7241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 MILLBROOK PLZ
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1911
Practice Address - Country:US
Practice Address - Phone:570-748-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30201966183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician