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NPI Code Detail

MEDICARE: DR. MICHAEL BLAIN PHARM. D

MEDICARE: DR. MICHAEL BLAIN PHARM. D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist4920123-1701UT
2183500000XPharmacist17569NV
3183500000XPharmacistRP00006710NM

General Provider Information

NPI Number : 1003138546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL BLAIN PHARM. D
Provider Business Mailing Address
First Line : 1770 W 4100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84119
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1770 W 4100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84119-4750
Country : US
Telephone Number : 801-977-0294
Fax Number : 801-747-1550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2010
Last Update Date : 02/25/2010

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Directions to “ DR. MICHAEL BLAIN PHARM. D” Practice Location

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