Provider Demographics
NPI:1174682884
Name:MCCLAIN, KATHERINE SUE (RPH)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:SUE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:SUE
Other - Last Name:APPLEGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1059 MANLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223
Mailing Address - Country:US
Mailing Address - Phone:770-412-6604
Mailing Address - Fax:
Practice Address - Street 1:315 S 8TH ST
Practice Address - Street 2:DAVIDS DRUG AND SURGICAL
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-227-6338
Practice Address - Fax:770-229-2571
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist