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NPI Code Detail

MEDICARE: CORD BLANCHARD

MEDICARE: CORD BLANCHARD
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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1194397026
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORD BLANCHARD
Provider Business Mailing Address
First Line : 4504 YELLOW HARBOR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-3251
Country : US
Telephone Number : 406-799-0401
Fax Number :
Provider Business Practice Location Address
First Line : 8410 FARM RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-8158
Country : US
Telephone Number : 702-658-6669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2021
Last Update Date : 07/12/2021

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Directions to “ CORD BLANCHARD ” Practice Location

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