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General NPI Number Information
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NPI Number | 1609329010
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Entity Type | Individual
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Provider Name | TERRY LYNN BLASINGAME
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Gender | Female
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 28200 HIGHWAY 189 # N150
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-9700
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Country | US
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Telephone | 909-336-3999
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Fax | 909-336-3997
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Provider Business Mailing Address
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Address Line | PO BOX 167
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-0167
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Country | US
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Telephone | 909-336-3999
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Fax | 909-336-3997
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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 | 32758
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License Number State | CA
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