Active NPI
Kelly Rae Clark, PHARM.D.
- Psychiatric Pharmacist
- Bronx, NY
National Provider Identifier
1003071150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Pharmacist
- License
- 41224
- Practice address
- 130 W Kingsbridge Rd
Bronx, NY 10468-3904 - Phone
- (718) 584-9000
- NPI assigned
- Jul 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Pharmacist | 1835P1300X | 41224 | TX | Primary |
Addresses
Primary practice location
130 W Kingsbridge Rd
Bronx, NY 10468-3904
Mailing address
130 W Kingsbridge Rd
Bronx, NY 10468-3904
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41224 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1003071150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 W KINGSBRIDGE RD",
"city": "BRONX",
"state": "NY",
"postal_code": "104683904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 W KINGSBRIDGE RD",
"city": "BRONX",
"state": "NY",
"postal_code": "104683904",
"telephone_number": "718-584-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KELLY",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-28",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1300X",
"taxonomy_group": "",
"desc": "Pharmacist, Psychiatric",
"state": "TX",
"license": "41224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.