Healthcare Provider Details

I. General information

NPI: 1649226887
Provider Name (Legal Business Name): RUSSELL EDWIN BLANCHARD JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY 114-U
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

2212 GLENDALE RD COUNTRY CLUB HILLS
AUGUSTA GA
30904-3434
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-733-2495
Mailing address:
  • Phone: 706-733-2495
  • Fax: 706-733-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH009429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: