Active NPI
Bradley Alan Blackburn, PHARMD
- Pharmacist
- Hutchinson, KS
National Provider Identifier
1710575154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1-108956
- Practice address
- 510 E 30TH Ave
Hutchinson, KS 67502-8431 - Phone
- (620) 663-2241
- NPI assigned
- Dec 31, 2020
- Last updated
- Mar 3, 2022
- 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 | 1-108956 | KS | Primary |
Addresses
Primary practice location
510 E 30TH Ave
Hutchinson, KS 67502-8431
Mailing address
510 E 30TH Ave
Hutchinson, KS 67502-8431
Phone (620) 663-2241
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 |
|---|---|---|---|
| 1-108956 | KS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen 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": "1609372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646265600000",
"number": "1710575154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 E 30TH AVE",
"city": "HUTCHINSON",
"state": "KS",
"postal_code": "675028431",
"telephone_number": "620-663-2241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 E 30TH AVE",
"city": "HUTCHINSON",
"state": "KS",
"postal_code": "675028431",
"telephone_number": "620-663-2241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "BRADLEY",
"middle_name": "ALAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-31",
"last_updated": "2022-03-03",
"certification_date": "2022-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KS",
"license": "1-108956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hutchinson, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.