Healthcare Provider Details

I. General information

NPI: 1720194921
Provider Name (Legal Business Name): RICHARD A BLAUVELT PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 S MERIDIAN ST
INDIANAPOLIS IN
46217-6056
US

IV. Provider business mailing address

332 OAK BROOKE LN
GREENWOOD IN
46142-3065
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-6833
  • Fax: 317-865-6832
Mailing address:
  • Phone: 317-865-6753
  • Fax: 317-865-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26014909A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: