Active NPI
Clark Stillahn
- Pharmacist
- York, NE
National Provider Identifier
1962764993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10736
- Practice address
- 533 S Lincoln Ave
York, NE 68467-4211 - Phone
- (402) 362-1280
- Fax
- (402) 362-1355
- NPI assigned
- Jun 14, 2012
- Sex
- Male
- 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 | 10736 | NE | Primary |
Addresses
Primary practice location
533 S Lincoln Ave
York, NE 68467-4211
Mailing address
533 S Lincoln Ave
York, NE 68467-4211
Phone (402) 362-1280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10736 | Other | NE | NEBRASKA STATE LICENSE 10736 |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10736 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1962764993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "533 S LINCOLN AVE",
"city": "YORK",
"state": "NE",
"postal_code": "684674211",
"telephone_number": "402-362-1280",
"fax_number": "402-362-1355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "533 S LINCOLN AVE",
"city": "YORK",
"state": "NE",
"postal_code": "684674211",
"telephone_number": "402-362-1280",
"fax_number": "402-362-1355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STILLAHN",
"first_name": "CLARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "10736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEBRASKA STATE LICENSE 10736",
"identifier": "10736",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in York, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.