Provider Demographics
NPI:1528316247
Name:MCCLENDON, TEARA (PHARM D)
Entity type:Individual
Prefix:
First Name:TEARA
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 N BLUE ANGEL PKWY
Mailing Address - Street 2:APT 2308
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-5042
Mailing Address - Country:US
Mailing Address - Phone:773-551-6240
Mailing Address - Fax:
Practice Address - Street 1:4711 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2607
Practice Address - Country:US
Practice Address - Phone:850-494-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist