Individual provider Active NPI

Charles Allen McClellan, R.PH.

  • Pharmacist
  • San Antonio, TX
National Provider Identifier
1942597570
Registry record updated Jul 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
43779 Issued in TX
Practice address
8223 State Highway 151
San Antonio, TX 78245-2104
Phone
(210) 247-0017
Fax
(210) 247-0017
NPI assigned
Jul 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 43779 TX Primary

Addresses

Primary practice location

8223 State Highway 151
San Antonio, TX 78245-2104

Mailing address

8223 State Highway 151
San Antonio, TX 78245-2104
Phone (210) 247-0017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
43779TXMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309737600000",
    "number": "1942597570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8223 STATE HIGHWAY 151",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782452104",
            "telephone_number": "210-247-0017",
            "fax_number": "210-247-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8223 STATE HIGHWAY 151",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782452104",
            "telephone_number": "210-247-0017",
            "fax_number": "210-247-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAN",
        "first_name": "CHARLES",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-04",
        "last_updated": "2011-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "43779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.