Active NPI
Mildaly Blanco, PHARMD
- Pharmacist
- Commerce, GA
National Provider Identifier
1568123545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH033430
- Practice address
- 2100 N Broad St
Commerce, GA 30529-1700 - Phone
- (706) 336-5931
- Fax
- (706) 336-8092
- NPI assigned
- Jan 3, 2022
- Last updated
- Dec 22, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH033430 | GA | Primary |
Addresses
Primary practice location
2100 N Broad St
Commerce, GA 30529-1700
Mailing address
742 Teal CT
Lawrenceville, GA 30043-3299
Phone (470) 372-7779
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | NA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH033430 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2100 N Broad St
Commerce, GA 30529
Phone (706) 336-5931
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1568123545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "742 TEAL CT",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300433299",
"telephone_number": "470-372-7779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 N BROAD ST",
"city": "COMMERCE",
"state": "GA",
"postal_code": "305291700",
"telephone_number": "706-336-5931",
"fax_number": "706-336-8092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANCO",
"first_name": "MILDALY",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-03",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH033430",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "NA",
"affiliation": "N",
"address_1": "742 Teal Ct",
"city": "Lawrenceville",
"state": "GA",
"country_code": "US",
"postal_code": "300433299",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Commerce, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.