Healthcare Provider Details

I. General information

NPI: 1265788798
Provider Name (Legal Business Name): BONNIE L BLUM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-3208
  • Fax: 716-845-8737
Mailing address:
  • Phone: 716-845-3208
  • Fax: 716-845-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number035296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: