Healthcare Provider Details

I. General information

NPI: 1144135229
Provider Name (Legal Business Name): JACINDA LYNN BLASA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20922 S CREEK RD
GRAFTON IL
62037-2282
US

IV. Provider business mailing address

20922 S CREEK RD
GRAFTON IL
62037-2282
US

V. Phone/Fax

Practice location:
  • Phone: 618-946-2066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051040234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: