Provider Demographics
NPI:1003039413
Name:BLAIR, RENEE BINDER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:BINDER
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HEMLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-9283
Mailing Address - Country:US
Mailing Address - Phone:606-878-7259
Mailing Address - Fax:
Practice Address - Street 1:11901 N HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-4859
Practice Address - Country:US
Practice Address - Phone:606-599-8891
Practice Address - Fax:606-598-0613
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54033725Medicaid