Paul R Blackburn, RPH
Individual provider Active NPI Pharmacist · Raton, NM
NPI 1730463290 · NPPES record last updated Sep 20, 2017
Key facts
- NPI
- 1730463290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP00005738 (NM)
- Practice address
- 955 S 2ND St
Raton, NM 87740-2301 - Phone
- (575) 445-3131
- Fax
- (575) 445-5393
- NPI assigned
- Oct 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00005738 | NM | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00005738 | NM | Yes |
Addresses
Primary practice location
955 S 2ND St
Raton, NM 87740-2301
Mailing address
955 S 2ND St
Raton, NM 87740-2301
Phone (575) 445-3131
Other providers in Raton, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.