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NPI Code Detail

MEDICARE: MR. WESLEY BLIZZARD RPH

MEDICARE: MR. WESLEY BLIZZARD RPH
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
1183500000XPharmacist27728CA

General Provider Information

NPI Number : 1023318250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WESLEY BLIZZARD RPH
Provider Business Mailing Address
First Line : 78210 VARNER RD
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-4134
Country : US
Telephone Number : 760-772-2764
Fax Number : 760-772-2783
Provider Business Practice Location Address
First Line : 78210 VARNER RD
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-4134
Country : US
Telephone Number : 760-772-2764
Fax Number : 760-772-2783
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2010
Last Update Date : 10/21/2010

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