Healthcare Provider Details

I. General information

NPI: 1194617076
Provider Name (Legal Business Name): JOSIE BLASIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 AIRPORT BLVD
PENSACOLA FL
32504-8633
US

IV. Provider business mailing address

18775 229TH ST
WALL SD
57790-6104
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-9057
  • Fax:
Mailing address:
  • Phone: 605-454-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS67462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: