MEDICARE: BLIA VANG 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
1	183500000X	Pharmacist	PD09808	AR
2	183500000X	Pharmacist	13508-040	WI

General Provider Information

NPI Number	:	1366723744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLIA VANG PHARM.D.

Provider Business Mailing Address
First Line	:	440 HWY 412 WEST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761
Country	:	US
Telephone Number	:	479-524-3671
Fax Number	:	479-524-3696

Provider Business Practice Location Address
First Line	:	440 HWY 412 WEST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761
Country	:	US
Telephone Number	:	479-524-3671
Fax Number	:	479-524-3696

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	02/16/2023

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Directions to “ BLIA VANG PHARM.D.” Practice Location

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