Provider Demographics
NPI:1770468092
Name:BLANKENSHIP, CLINT (PHARMD, PA-C, RPH)
Entity type:Individual
Prefix:PROF
First Name:CLINT
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PHARMD, PA-C, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151B RUTLEDGE AVE # MSC962
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8903
Mailing Address - Country:US
Mailing Address - Phone:843-792-7490
Mailing Address - Fax:
Practice Address - Street 1:151B RUTLEDGE AVE # MSC962
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-792-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant