Healthcare Provider Details

I. General information

NPI: 1700482742
Provider Name (Legal Business Name): ASHLEY BLANCHARD PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 HAMBURG TPKE
WAYNE NJ
07470-6226
US

IV. Provider business mailing address

79 OAKWOOD VLG
FLANDERS NJ
07836-9077
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3400
  • Fax:
Mailing address:
  • Phone: 908-645-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04057600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: