Active NPI
Brandon Lee Blackburn, PHARMD
- Pharmacist
- High Point, NC
National Provider Identifier
1679304505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 33366
- Practice address
- 904 N Main St
High Point, NC 27262-3924 - Phone
- (336) 887-1036
- NPI assigned
- Aug 12, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 33366 | NC | Primary |
Addresses
Primary practice location
904 N Main St
High Point, NC 27262-3924
Mailing address
612 Clark Ave
Greensboro, NC 27406-6606
Phone (336) 681-4602
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 |
|---|---|---|---|
| 33366 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
904 N Main St
High Point, NC 27262
Phone (336) 861-2062
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": "1723420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723420800000",
"number": "1679304505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 CLARK AVE",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274066606",
"telephone_number": "336-681-4602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "904 N MAIN ST",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272623924",
"telephone_number": "336-887-1036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "BRANDON",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-12",
"last_updated": "2024-08-12",
"certification_date": "2024-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "33366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.