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General NPI Number Information
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NPI Number | 1194320127
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Entity Type | Individual
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Provider Name | NATHAN ANDREW BLASDEL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 207 W JOURDAN ST
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City | NEWTON
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State | IL
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Zip | 62448-1930
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Country | US
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Telephone | 618-783-2473
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Fax |
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Provider Business Mailing Address
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Address Line | 424 COUNTY ROAD 1350 N
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City | WAYNE CITY
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State | IL
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Zip | 62895-0420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.295301
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License Number State | IL
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