Healthcare Provider Details

I. General information

NPI: 1902045255
Provider Name (Legal Business Name): BLANDON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ANNA AVE
BLANDON PA
19510-9310
US

IV. Provider business mailing address

104 ANNA AVE
BLANDON PA
19510-9310
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-8899
  • Fax: 610-944-0888
Mailing address:
  • Phone: 610-944-8899
  • Fax: 610-944-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481887
License Number StatePA

VIII. Authorized Official

Name: MR. ADNAN SHUBBAR
Title or Position: MANAGER
Credential: R.PH.
Phone: 610-504-1316