Healthcare Provider Details

I. General information

NPI: 1992134571
Provider Name (Legal Business Name): BENJAMIN BLOMEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 B DR N MEIJER PHARMACY, STORE 195
BATTLE CREEK MI
49014-7573
US

IV. Provider business mailing address

9201 S 6TH ST
KALAMAZOO MI
49009-8937
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6610
  • Fax: 269-979-6665
Mailing address:
  • Phone: 269-384-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302032523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: