Provider Demographics
NPI:1538407952
Name:MCCLAIN, PATRICK DEWAYNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DEWAYNE
Last Name:MCCLAIN
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 1:108 PAVILION PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4056
Mailing Address - Country:US
Mailing Address - Phone:770-460-4106
Mailing Address - Fax:770-716-0674
Practice Address - Street 1:108 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4056
Practice Address - Country:US
Practice Address - Phone:770-460-4106
Practice Address - Fax:770-716-0674
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist