Provider Demographics
NPI:1366985830
Name:MCCLUNG, BORA (PHARMD)
Entity type:Individual
Prefix:
First Name:BORA
Middle Name:
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BORA
Other - Middle Name:
Other - Last Name:RA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16199 BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4201
Mailing Address - Country:US
Mailing Address - Phone:503-682-4435
Mailing Address - Fax:
Practice Address - Street 1:16199 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4201
Practice Address - Country:US
Practice Address - Phone:503-682-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist