Glen Russel Blackford, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

03109939 Issued in OH

Practice address

345 N Sandusky Ave
Bucyrus, OH 44820-1806

Phone

(419) 562-4222

Fax

(419) 562-4516

NPI assigned

Apr 9, 2021

Last updated

Apr 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Locations

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

• Medicine Shoppe 1088 LLC

  dba Medicine Shoppe 1088 LTC

  • Long Term Care Pharmacy
  • Bucyrus, OH
  • NPI 1255932349
  NPD
• Medicine Shoppe 1088 LLC

  dba Medicine Shoppe 1088

  • Community/Retail Pharmacy
  • Bucyrus, OH
  • NPI 1083607923
  NPD (past)

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1417537994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448201806",
            "telephone_number": "419-562-4222",
            "fax_number": "419-562-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448201806",
            "telephone_number": "419-562-4222",
            "fax_number": "419-562-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKFORD",
        "first_name": "GLEN",
        "middle_name": "RUSSEL",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03109939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Binion, LPN
• Bio-Medical Applications of Ohio, Inc. (Crawford County Kidney Center)
• Brittany Bishop
• David C Black, D.C.
• Kim Ann Blackburn
• Keith David Blair, MD
• Nicole C. Blamer, LSW
• Marjorie E Blankenship, PTA
• Brandi L Blanton, CNP
• Alexa Borello, PHARMD

• Pharmacist in Bucyrus, OH
• Providers in Bucyrus, OH by specialty
• Pharmacist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; 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.