Active NPI
Benjamin David Blitzblau, PHARMD
- Pharmacotherapy Pharmacist
- Loves Park, IL
National Provider Identifier
1699097865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 051290077
- Practice address
- 1515 E Riverside Blvd
Kmart Pharmacy
Loves Park, IL 61111-4742 - Phone
- (815) 877-8059
- Fax
- (815) 282-4992
- NPI assigned
- Feb 15, 2010
- 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 |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 051290077 | IL | Primary |
Addresses
Primary practice location
1515 E Riverside Blvd
Kmart Pharmacy
Loves Park, IL 61111-4742
Mailing address
1515 E Riverside Blvd
Kmart Pharmacy
Loves Park, IL 61111-4742
Phone (815) 877-8059
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 |
|---|---|---|---|
| 051290077 | IL | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266192000000",
"number": "1699097865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 E RIVERSIDE BLVD",
"address_2": "KMART PHARMACY",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611114742",
"telephone_number": "815-877-8059",
"fax_number": "815-282-4992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 E RIVERSIDE BLVD",
"address_2": "KMART PHARMACY",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611114742",
"telephone_number": "815-877-8059",
"fax_number": "815-282-4992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLITZBLAU",
"first_name": "BENJAMIN",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-15",
"last_updated": "2010-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "IL",
"license": "051290077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.