Provider Demographics
NPI:1700357621
Name:MCCLIMENT, SHAWNA
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:MCCLIMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-2146
Mailing Address - Country:US
Mailing Address - Phone:814-342-1752
Mailing Address - Fax:
Practice Address - Street 1:501 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2146
Practice Address - Country:US
Practice Address - Phone:814-342-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3336C0003XMedicaid