Active NPI
Stephanie Lee Clack, PHARMD, RPH
- Pharmacist
- Piqua, OH
National Provider Identifier
1164024790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03326853
- Practice address
- 1300 E Ash St
Piqua, OH 45356-4100 - Phone
- (937) 615-9968
- Fax
- (937) 615-9972
- NPI assigned
- Nov 9, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03326853 | OH | Primary |
Addresses
Primary practice location
1300 E Ash St
Piqua, OH 45356-4100
Mailing address
1300 E Ash St
Piqua, OH 45356-4100
Phone (937) 615-9968
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, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03326853 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1164024790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 E ASH ST",
"city": "PIQUA",
"state": "OH",
"postal_code": "453564100",
"telephone_number": "937-615-9968",
"fax_number": "937-615-9972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 E ASH ST",
"city": "PIQUA",
"state": "OH",
"postal_code": "453564100",
"telephone_number": "937-615-9968",
"fax_number": "937-615-9972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLACK",
"first_name": "STEPHANIE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHARMD, RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03326853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Piqua, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.