Active NPI
Gary Blackburn, PHARMD, RPH
- Pharmacist
- Pendleton, OR
National Provider Identifier
1356749972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0010717
- Practice address
- 2801 St Anthony Way
Pendleton, OR 97801-3800 - Phone
- (541) 276-5121
- NPI assigned
- Dec 13, 2014
- Last updated
- Dec 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0010717 | OR | Primary |
| Pharmacist | 183500000X | PH 00062359 | WA | |
| Pharmacist | 183500000X | P6220 | ID |
Addresses
Primary practice location
2801 St Anthony Way
Pendleton, OR 97801-3800
Mailing address
2801 St Anthony Way
Pendleton, OR 97801-3800
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6220 | ID | MD | Pharmacist |
| RPH-0010717 | OR | MD | Pharmacist |
| PH 00062359 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1418428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418428800000",
"number": "1356749972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 ST ANTHONY WAY",
"city": "PENDLETON",
"state": "OR",
"postal_code": "978013800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 ST ANTHONY WAY",
"city": "PENDLETON",
"state": "OR",
"postal_code": "978013800",
"telephone_number": "541-276-5121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "GARY",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-12-13",
"last_updated": "2014-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0010717",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH 00062359",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6220",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pendleton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.