Bill E Blalack, RPH
Individual provider Active NPI Pharmacist · Brookhaven, MS
NPI 1194034264 · NPPES record last updated Oct 6, 2010
Key facts
- NPI
- 1194034264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD05554 (AR)
- Practice address
- 218 S Whitworth Ave
Brookhaven, MS 39601-3343 - Phone
- (601) 835-0370
- Fax
- (601) 835-3376
- NPI assigned
- Oct 6, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|
| PD05554 | AR | MD | Pharmacist |
| 5911 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients | |
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD05554 | AR | Yes |
| Pharmacist | 183500000X | 5911 | MS |
Addresses
Primary practice location
218 S Whitworth Ave
Brookhaven, MS 39601-3343
Mailing address
218 S Whitworth Ave
Brookhaven, MS 39601-3343
Phone (601) 835-0370
Other providers in Brookhaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2010. 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.