Healthcare Provider Details

I. General information

NPI: 1306152038
Provider Name (Legal Business Name): CARRIE LYNNE BLOSE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 POINT PLZ
BUTLER PA
16001-2540
US

IV. Provider business mailing address

178 POINT PLZ
BUTLER PA
16001-2540
US

V. Phone/Fax

Practice location:
  • Phone: 724-285-5800
  • Fax: 724-285-5580
Mailing address:
  • Phone: 724-285-5800
  • Fax: 724-285-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035141L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: