A Blair Lundberg, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

RP029059L Issued in PA

Practice address

34 East 4TH St
Emporium, PA 15834

Phone

(814) 486-3310

Fax

(814) 486-0974

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abl Custom Compounding

  • Compounding Pharmacy
  • Emporium, PA
  • NPI 1558498634
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1346207925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 EAST 4TH ST",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "15834",
            "telephone_number": "814-486-2326",
            "fax_number": "814-486-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 EAST 4TH ST",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "15834",
            "telephone_number": "814-486-3310",
            "fax_number": "814-486-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDBERG",
        "first_name": "A",
        "middle_name": "BLAIR",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP029059L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009393900002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3989374",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keystone Rural Health Consortia, Inc.
• Keystone Rural Health Consortia, Inc.
• Savanah Marie Krivonyak, RDH, PHDHP
• Victor Lahnovych, MD
• Thomas Luchs
• Donna McKimm, RN, CRNP
• Renee Mostyn
• Valerie Lynn Nolder, LPC, MFT
• Miranda Peiper, LPC
• Jodi Rae Regulski, P.A.-C

• Pharmacist in Emporium, PA
• Providers in Emporium, PA by specialty
• Pharmacist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.