1982683462 NPI number — DR. PHILIP JOSEPH BLAINE PHARM.D.

Table of content: DR. PHILIP JOSEPH BLAINE PHARM.D. (NPI 1982683462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982683462 NPI number — DR. PHILIP JOSEPH BLAINE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAINE
Provider First Name:
PHILIP
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982683462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
613 IVANHOE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23322-8865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-410-5100
Provider Business Mailing Address Fax Number:
757-953-0477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 JOHN PAUL JONES CIR
Provider Second Line Business Practice Location Address:
SUITE 1400
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23708-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-953-7718
Provider Business Practice Location Address Fax Number:
757-953-0477
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  1-11487 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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