MEDICARE: SAMANTHA V BLANDFORD PHARMD

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	017097	KY

General Provider Information

NPI Number	:	1437564978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA V BLANDFORD PHARMD

Provider Business Mailing Address
First Line	:	340 CHASE PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2888
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 RICHMOND RD N
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1319
Country	:	US
Telephone Number	:	859-986-1494
Fax Number	:

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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