Provider Demographics
NPI:1003401761
Name:BLAZIER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BLAZIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 LACKLAND HILL PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3569
Mailing Address - Country:US
Mailing Address - Phone:314-344-9094
Mailing Address - Fax:314-344-9097
Practice Address - Street 1:1884 LACKLAND HILL PKWY STE 6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3569
Practice Address - Country:US
Practice Address - Phone:314-344-9094
Practice Address - Fax:314-344-9097
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist