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NPI Code Detail

MEDICARE: MR. GREGORY ROBERT BLAIES RPH

MEDICARE: MR. GREGORY ROBERT BLAIES RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2006038801MO

General Provider Information

NPI Number : 1053583898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY ROBERT BLAIES RPH
Provider Business Mailing Address
First Line : 3168 RIVERPORT TECH CENTER DR
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-4825
Country : US
Telephone Number : 314-702-7445
Fax Number :
Provider Business Practice Location Address
First Line : 3168 RIVERPORT TECH CENTER DR
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-4825
Country : US
Telephone Number : 314-702-7445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2008
Last Update Date : 04/01/2008

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