MEDICARE: BLSRPH, INC

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	3336C0003X	Community/Retail Pharmacy	13173	NC

General Provider Information

NPI Number	:	1285172197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLSRPH, INC

Provider Business Mailing Address
First Line	:	PO BOX 148
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-0148
Country	:	US
Telephone Number	:	910-646-3435
Fax Number	:	910-646-4056

Provider Business Practice Location Address
First Line	:	108 E OLD HIGHWAY 74 76
Second Line	:
City	:	LAKE WACCAMAW
State	:	NC
Zip	:	28450-2512
Country	:	US
Telephone Number	:	910-646-3435
Fax Number	:	910-646-4056

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	BENJAMIN LEWIS SAULS
Credential	:	R.PH
Telephone Number	:	910-646-3435

Provider Enumeration Date	:	02/11/2017
Last Update Date	:	02/11/2017

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Directions to “BLSRPH, INC ” Practice Location

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