Provider Demographics
NPI:1053928192
Name:MCCLAIN, FERRYL BOYANCE (RPH DPH)
Entity type:Individual
Prefix:
First Name:FERRYL
Middle Name:BOYANCE
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:RPH DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 E DEER HOLLOW LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9187
Mailing Address - Country:US
Mailing Address - Phone:346-476-2683
Mailing Address - Fax:
Practice Address - Street 1:1940 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5934
Practice Address - Country:US
Practice Address - Phone:520-206-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS027234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist