Bob L Blackburn, DPH
Individual provider Active NPI Pharmacist · Owasso, OK
NPI 1750650883 · NPPES record last updated Dec 19, 2011
Key facts
- NPI
- 1750650883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 7135 (OK)
- Practice address
- 13806 E 94TH St N
Owasso, OK 74055-4566 - Phone
- (918) 272-2827
- NPI assigned
- Dec 19, 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7135 | OK | Yes |
Addresses
Primary practice location
13806 E 94TH St N
Owasso, OK 74055-4566
Mailing address
13806 E 94TH St N
Owasso, OK 74055-4566
Phone (918) 272-2827
Other providers in Owasso, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2011. 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.