Provider Demographics
NPI:1003462607
Name:BLADEN, NEIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:BLADEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 N JAKE GAYLE RD
Mailing Address - Street 2:
Mailing Address - City:COMMISKEY
Mailing Address - State:IN
Mailing Address - Zip Code:47227-9320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3511
Practice Address - Country:US
Practice Address - Phone:812-522-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024703A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist