Healthcare Provider Details

I. General information

NPI: 1033780903
Provider Name (Legal Business Name): JENNA LEA BLUNT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST OSLER BUILDING 126
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1800 ORLEANS ST OSLER BUILDING 126
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 641-521-0387
  • Fax:
Mailing address:
  • Phone: 641-521-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number24976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: