Healthcare Provider Details

I. General information

NPI: 1891000519
Provider Name (Legal Business Name): BENJAMIN PRESTON BLANKINCHIP RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENNIE PRESTON BLANKINCHIP

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4739 SAINT STEPHENS RD
PRICHARD AL
36613-3512
US

IV. Provider business mailing address

12230 LOTT RD
CHUNCHULA AL
36521-3350
US

V. Phone/Fax

Practice location:
  • Phone: 251-457-6666
  • Fax: 251-330-3206
Mailing address:
  • Phone: 251-866-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7624
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: