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NPI Code Detail

MEDICARE: JAMIE BLUM

MEDICARE: JAMIE BLUM
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
1183500000XPharmacist20718NC

General Provider Information

NPI Number : 1508162140
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE BLUM
Provider Business Mailing Address
First Line : 8711 BOHAM CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2325 VILLAGE LAKE DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-0081
Country : US
Telephone Number : 704-536-3663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2011
Last Update Date : 01/30/2011

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Directions to “ JAMIE BLUM ” Practice Location

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