MEDICARE: MR. BENJAMIN PRESTON BLANKINCHIP RPH

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	7624	AL

General Provider Information

NPI Number	:	1891000519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN PRESTON BLANKINCHIP RPH

Provider Business Mailing Address
First Line	:	12230 LOTT RD
Second Line	:
City	:	CHUNCHULA
State	:	AL
Zip	:	36521-3350
Country	:	US
Telephone Number	:	251-866-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	4739 SAINT STEPHENS RD
Second Line	:
City	:	PRICHARD
State	:	AL
Zip	:	36613-3512
Country	:	US
Telephone Number	:	251-457-6666
Fax Number	:	251-330-3206

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

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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