Active NPI
Elbert Blackburn III, RPH
- Pharmacist
- London, KY
National Provider Identifier
1699507616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 010229
- Practice address
- 2104 N Main St
London, KY 40741-1026 - Phone
- (606) 878-7344
- NPI assigned
- Aug 19, 2024
- Sex
- Male
- 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 | 010229 | KY | Primary |
Addresses
Primary practice location
2104 N Main St
London, KY 40741-1026
Mailing address
43 Briar LN
London, KY 40741-9285
Phone (606) 434-4837
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010229 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kentucky CVS Pharmacy, L.L.C | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1699507616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 BRIAR LN",
"city": "LONDON",
"state": "KY",
"postal_code": "407419285",
"telephone_number": "606-434-4837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 N MAIN ST",
"city": "LONDON",
"state": "KY",
"postal_code": "407411026",
"telephone_number": "606-878-7344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "ELBERT",
"name_suffix": "III",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-08-19",
"last_updated": "2024-08-19",
"certification_date": "2024-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "010229",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in London, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.