Active NPI
Ebony Blue
- Pharmacist
- Dublin, GA
National Provider Identifier
1629415815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH024954
- Practice address
- 1100 Hillcrest Pkwy
Dublin, GA 31021-4366 - Phone
- (478) 277-3085
- NPI assigned
- May 28, 2013
- Last updated
- May 28, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | RPH024954 | GA | Primary |
Addresses
Primary practice location
1100 Hillcrest Pkwy
Dublin, GA 31021-4366
Mailing address
456 Bridgemill Dr
East Dublin, GA 31027-8313
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH024954 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Kroger Co | Past | Accepting new patients | |
| Kroger Co | Past | Accepting new patients |
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": "1369699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369699200000",
"number": "1629415815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "456 BRIDGEMILL DR",
"city": "EAST DUBLIN",
"state": "GA",
"postal_code": "310278313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 HILLCREST PKWY",
"city": "DUBLIN",
"state": "GA",
"postal_code": "310214366",
"telephone_number": "478-277-3085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE",
"first_name": "EBONY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-28",
"last_updated": "2013-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH024954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.