Healthcare Provider Details

I. General information

NPI: 1336458181
Provider Name (Legal Business Name): BENJAMIN WALTER BLAIR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 HILLSDALE LOOP
SAN ANTONIO TX
78249-3889
US

IV. Provider business mailing address

11022 HILLSDALE LOOP
SAN ANTONIO TX
78249-3889
US

V. Phone/Fax

Practice location:
  • Phone: 210-213-9562
  • Fax:
Mailing address:
  • Phone: 210-213-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number41728
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: