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General NPI Number Information
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NPI Number | 1407960032
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Entity Type | Individual
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Provider Name | STEVEN ALLEN BLACKWELL PH.D., J.D., R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7500 SECURITY BLVD # C3-20-17 CENTERS FOR MEDICARE & MEDICAID SERVICES
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City | BALTIMORE
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State | MD
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Zip | 21244-1849
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Country | US
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Telephone | 410-786-6852
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 KINGS MILL WAY
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City | OWINGS MILLS
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State | MD
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Zip | 21117-6601
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Country | US
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Telephone | 443-394-0591
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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 | 15124
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6081
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License Number State | TN
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