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General NPI Number Information
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NPI Number | 1710263090
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Entity Type | Individual
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Provider Name | TRUDI-ANN BLACKELLAR PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 10200 OLIVEWOOD WAY UNIT 39
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City | ESTERO
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State | FL
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Zip | 33928-7404
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Country | US
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Telephone | 954-636-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 28100 S TAMIAMI TRL
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3203
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Country | US
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Telephone | 239-495-8552
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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 | PS46876
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License Number State | FL
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