=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023908852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BY BLEND, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6171 HUNTLEY RD STE J
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-292-0499
-----------------------------------------------------
Fax | 380-215-3850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6171 HUNTLEY RD STE J
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43229-1047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-292-0499
-----------------------------------------------------
Fax | 380-215-3850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, PHARMACIST-IN-CHARGE
-----------------------------------------------------
Name | DR. DANIEL DISTEFANO
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 800-292-0499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------