Healthcare Provider Details

I. General information

NPI: 1871119115
Provider Name (Legal Business Name): KATELIND A BLOSSER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W HIGH AVE
NEW PHILADELPHIA OH
44663-2057
US

IV. Provider business mailing address

1554 LAKE RD NW
DOVER OH
44622-9613
US

V. Phone/Fax

Practice location:
  • Phone: 330-339-2565
  • Fax:
Mailing address:
  • Phone: 330-605-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: