Provider Demographics
NPI:1487395349
Name:MCCLASKEY, DIANE M (RPH, BCPS)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:MCCLASKEY
Suffix:
Gender:F
Credentials:RPH, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3099
Mailing Address - Country:US
Mailing Address - Phone:417-328-7562
Mailing Address - Fax:417-328-1175
Practice Address - Street 1:1500 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3099
Practice Address - Country:US
Practice Address - Phone:417-328-7562
Practice Address - Fax:417-328-1175
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA173631835P1200X
MO0430751835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy