Healthcare Provider Details

I. General information

NPI: 1790485175
Provider Name (Legal Business Name): ALYSSA BLOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LEADERS HEIGHTS RD
YORK PA
17403-5138
US

IV. Provider business mailing address

215 REYNOLDS MILL RD
YORK PA
17403-9549
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-0823
  • Fax:
Mailing address:
  • Phone: 717-668-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: