MEDICARE: ANDREA MARIE BLUM PHARMD

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
1	1835P0200X	Pediatric Pharmacist	03236997	OH
2	1835P0200X	Pediatric Pharmacist	063297	NY

General Provider Information

NPI Number	:	1164123287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MARIE BLUM PHARMD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # HB-105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # HB-105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-210-1148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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Directions to “ ANDREA MARIE BLUM PHARMD” Practice Location

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