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General NPI Number Information
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NPI Number | 1275800476
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Entity Type | Individual
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Provider Name | JAY C BLANCHARD RPH
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Gender | Male
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | W156N11261 PILGRIM RD
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City | GERMANTOWN
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State | WI
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Zip | 53022-3420
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Country | US
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Telephone | 262-253-9720
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Fax | 262-253-1734
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Provider Business Mailing Address
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Address Line | 4535 W MIDLAND DR
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City | MILWAUKEE
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State | WI
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Zip | 53219-4841
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Country | US
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Telephone | 414-541-6324
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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 | 10497-40
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License Number State | WI
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