Healthcare Provider Details

I. General information

NPI: 1376693614
Provider Name (Legal Business Name): BLUMON CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST # 69
CAMBRIDGE WI
53523-9141
US

IV. Provider business mailing address

109 W MAIN ST # 69
CAMBRIDGE WI
53523-9141
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-3231
  • Fax: 608-423-7128
Mailing address:
  • Phone: 608-423-3231
  • Fax: 608-423-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7530-42
License Number StateWI

VIII. Authorized Official

Name: MATT MABIE
Title or Position: OWNER
Credential:
Phone: 608-347-5420