=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336934272
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE S CLARK PHARMD, BCPP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3811 OHARA ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-586-9611
-----------------------------------------------------
Fax | 412-246-6110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3811 OHARA ST
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15213-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-586-9611
-----------------------------------------------------
Fax | 412-246-6110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1300X
-----------------------------------------------------
Taxonomy Name | Psychiatric Pharmacist
-----------------------------------------------------
License Number | RP448452
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------