Provider Demographics
NPI:1134840473
Name:MCCLELLAN, ROBERT JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12063 S 540 E
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9009
Mailing Address - Country:US
Mailing Address - Phone:801-349-0615
Mailing Address - Fax:
Practice Address - Street 1:1220 E 3900 S STE 1H
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-477-8304
Practice Address - Fax:801-997-8404
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9801291-8911183500000X
UT9801291-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist