Provider Demographics
NPI:1063492775
Name:ST.DENNIS, CLARKE (RPH, PHD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:CLARKE
Middle Name:
Last Name:ST.DENNIS
Suffix:
Gender:M
Credentials:RPH, PHD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S KAHUNA DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-3243
Mailing Address - Country:US
Mailing Address - Phone:509-220-9326
Mailing Address - Fax:509-358-7744
Practice Address - Street 1:850 WEST MAPLE STREET
Practice Address - Street 2:EASTERN STATE HOSPITAL
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022
Practice Address - Country:US
Practice Address - Phone:509-299-4466
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000093201835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric