MEDICARE: STEVEN ALLEN BLACKWELL PH.D., J.D., R.PH.

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	15124	MD
2	183500000X	Pharmacist	6081	TN

General Provider Information

NPI Number	:	1407960032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ALLEN BLACKWELL PH.D., J.D., R.PH.

Provider Business Mailing Address
First Line	:	4600 KINGS MILL WAY
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-6601
Country	:	US
Telephone Number	:	443-394-0591
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SECURITY BLVD # C3-20-17
Second Line	:	CENTERS FOR MEDICARE & MEDICAID SERVICES
City	:	BALTIMORE
State	:	MD
Zip	:	21244-1849
Country	:	US
Telephone Number	:	410-786-6852
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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