Fred C Blumhagen, RPH
Individual provider Active NPI Pharmacist · Villa Park, IL
NPI 1194005744 · NPPES record last updated Aug 26, 2011
Key facts
- NPI
- 1194005744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051028451 (IL)
- Practice address
- 200 E Roosevelt Rd
Villa Park, IL 60181-3500 - Phone
- (630) 993-0869
- Fax
- (630) 993-1296
- NPI assigned
- Aug 26, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051028451 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051028451 | IL | Yes |
Addresses
Primary practice location
200 E Roosevelt Rd
Villa Park, IL 60181-3500
Mailing address
200 E Roosevelt Rd
Villa Park, IL 60181-3500
Phone (630) 993-0869
Other providers in Villa Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.