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General NPI Number Information
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NPI Number | 1780299479
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Entity Type | Individual
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Provider Name | KATHLEEN BRADLEY BLUM RPH
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 8456 PEOSTA COMMERCIAL CT
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City | PEOSTA
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State | IA
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Zip | 52068-7123
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Country | US
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Telephone | 563-557-2950
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Fax | 563-557-2955
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Provider Business Mailing Address
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Address Line | 4997 ROUTE 61
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City | ZWINGLE
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State | IA
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Zip | 52079-9623
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Country | US
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Telephone | 563-557-2950
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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 | 17425-40
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License Number State | WI
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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 | 26015901A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16733
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License Number State | IA
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