Healthcare Provider Details

I. General information

NPI: 1245096304
Provider Name (Legal Business Name): CLAIRESSA CIUPAK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E STATE ST
ATHENS OH
45701-2138
US

IV. Provider business mailing address

9401 MENTOR AVE # 171
MENTOR OH
44060-4519
US

V. Phone/Fax

Practice location:
  • Phone: 740-589-3181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442158
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: