MEDICARE: THOMAS L. BLUMENBERG R.PH., MPH

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	8800	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	677939 1	OTHER	WI	EIN

General Provider Information

NPI Number	:	1942402144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L. BLUMENBERG R.PH., MPH

Provider Business Mailing Address
First Line	:	10718 N CLEAR LAKE DR
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-7645
Country	:	US
Telephone Number	:	715-462-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	10718 N CLEAR LAKE DR
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-7645
Country	:	US
Telephone Number	:	715-462-4821
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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