Basic Information
| Provider Information | |||||||||
| NPI: | 1619518461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLIVE | ||||||||
| FirstName: | PIA | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 GREEN ST UNIT D177 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015103043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618604475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 BELMONT ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | PH237622 | MA | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P1200X | PH237622 | MA | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.