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NPI Code Detail

MEDICARE: MICHELLE DUVALL BLANTON D.PH.

MEDICARE: MICHELLE DUVALL BLANTON D.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
1183500000XPharmacist8375TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10202009368OTHERVAPHARMACIST LICENSE
28375OTHERTNDOCTOR OF PHARMACY LICENS

General Provider Information

NPI Number : 1972717072
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DUVALL BLANTON D.PH.
Provider Business Mailing Address
First Line : 1616 E MAIN ST
Second Line :
City : HUMBOLDT
State : TN
Zip : 38343-2904
Country : US
Telephone Number : 731-784-3610
Fax Number : 731-784-9989
Provider Business Practice Location Address
First Line : 1616 E MAIN ST
Second Line :
City : HUMBOLDT
State : TN
Zip : 38343-2904
Country : US
Telephone Number : 731-784-3610
Fax Number : 731-784-9989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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