Blairco, Inc.

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

263083 Issued in MN

Legal business name

BLAIRCO, INC.

Doing business as

Trail Creek Health Center

Practice address

120 N Augusta CT Ste 103
Mankato, MN 56001-7720

Phone

(507) 345-4302

Fax

(507) 387-2917

NPI assigned

Sep 8, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brent E Blair, PHARMD

Title

President

Phone

(507) 345-4302

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Trail Creek Health Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1811145436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N AUGUSTA CT STE 103",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017720",
            "telephone_number": "507-345-4302",
            "fax_number": "507-387-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N AUGUSTA CT STE 103",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017720",
            "telephone_number": "507-345-4302",
            "fax_number": "507-387-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAIRCO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-08",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "507-345-4302",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MN",
            "license": "263083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BOARD OF PHARMACY",
            "identifier": "263083",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trail Creek Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Susan Birkholz, M.D.
• Rosean Bishop, PHD
• Erin E Bissonnette, RN, NP
• Patricia Wray Bjerke
• Krista Kaye Bjorum
• Ashley Blanchard, L.AC.
• Douglas D Blanchard, M.OM., L.AC.
• Devin Eugene Blaness
• Stacy Marie Blank, CNP
• Brooklyn Marae Blasing

• Compounding Pharmacy in Mankato, MN
• Providers in Mankato, MN by specialty
• Compounding Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.