Active NPI
Kristopher Brent Blaylock, RPH
- Pharmacist
- Bossier City, LA
National Provider Identifier
1073947784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15947
- Practice address
- 801 Benton Rd
Bossier City, LA 71111 - Phone
- (318) 742-3509
- Fax
- (318) 742-7730
- NPI assigned
- Aug 29, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15947 | LA | Primary |
Addresses
Primary practice location
801 Benton Rd
Bossier City, LA 71111
Mailing address
801 Benton Rd
Bossier City, LA 71111-3743
Phone (318) 742-3509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LA 15947 | Other | LA | PHARMACIST LA 15947 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15947 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377734400000",
"number": "1073947784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 BENTON RD",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711113743",
"telephone_number": "318-742-3509",
"fax_number": "318-742-7730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BENTON RD",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "71111",
"telephone_number": "318-742-3509",
"fax_number": "318-742-7730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "KRISTOPHER",
"middle_name": "BRENT",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-29",
"last_updated": "2013-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "15947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LA 15947",
"identifier": "LA 15947",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.