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General NPI Number Information
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NPI Number | 1376693614
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Entity Type | Organization
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Legal Business Name | BLUMON CORPORATION
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 109 W MAIN ST # 69
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City | CAMBRIDGE
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State | WI
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Zip | 53523-9141
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Country | US
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Telephone | 608-423-3231
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Fax | 608-423-7128
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Provider Business Mailing Address
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Address Line | 109 W MAIN ST # 69
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City | CAMBRIDGE
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State | WI
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Zip | 53523-9141
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Country | US
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Telephone | 608-423-3231
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Fax | 608-423-7128
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Authorized Official
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Title or Position | OWNER
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Name | MATT MABIE
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Credential |
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Telephone | 608-347-5420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 7530-42
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License Number State | WI
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