Shaun Blalack, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS61109 Issued in FL

Practice address

340 NW Commerce Dr
Lake City, FL 32055-4709

Phone

(386) 719-9343

NPI assigned

Dec 7, 2020

Last updated

Apr 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

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.

• Walgreen Co

  dba Walgreens #09617

  • Pharmacy
  • Gainesville, FL
  • NPI 1457436396
  NPD
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1841896834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9125 NW 39TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326067372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 NW COMMERCE DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554709",
            "telephone_number": "386-719-9343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9125 NW 39th Ave",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326067372",
            "country_code": "US",
            "telephone_number": "352-378-3282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLALACK",
        "first_name": "SHAUN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-07",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS61109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Florida, Inc. (Bma Lake City)
• Bio-Medical Applications of Florida, Inc. (Fresenius Medical Care Lake City West)
• Bio-Medical Applications of Florida, Inc. (Fresenius Medical Care Lake City Home)
• Michele Love Bird
• Terry S Birman
• Alec Blanco
• Melody Sue Blankenship, RRT
• Nancy Thedis Blanton, LCSW
• Jennifer Blue
• Jean Blum, LMT

• Pharmacist in Lake City, FL
• Providers in Lake City, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.