Ben D Blackburn, DPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

12179 Issued in OK

Practice address

16657 E 122ND St N
Collinsville, OK 74021-5180

Phone

(918) 688-8578

NPI assigned

Aug 29, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1932480498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12802 E 96TH ST N",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740555371",
            "telephone_number": "918-272-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16657 E 122ND ST N",
            "city": "COLLINSVILLE",
            "state": "OK",
            "postal_code": "740215180",
            "telephone_number": "918-688-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "BEN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "DPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-29",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OK",
            "license": "12179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100234240",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100234240T",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Collinsville, OK
• Providers in Collinsville, OK by specialty
• Pharmacist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; 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.