MEDICARE: NANCY ANN BLUE 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
1	183500000X	Pharmacist	051.034001	IL
2	183500000X	Pharmacist	26013736A	IN

General Provider Information

NPI Number	:	1215538046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN BLUE RPH

Provider Business Mailing Address
First Line	:	229 DENVALE DR
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-1208
Country	:	US
Telephone Number	:	217-799-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 N VERMILION ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-5997
Country	:	US
Telephone Number	:	217-443-9587
Fax Number	:	217-443-9553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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Directions to “ NANCY ANN BLUE RPH” Practice Location

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