Provider Demographics
NPI:1023569787
Name:BLACKSTON, WENDY (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BLACKSTON
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 1:3101 FOX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9543
Mailing Address - Country:US
Mailing Address - Phone:901-288-3223
Mailing Address - Fax:410-531-1252
Practice Address - Street 1:3101 FOX VALLEY DR
Practice Address - Street 2:
Practice Address - City:WEST FRIENDSHIP
Practice Address - State:MD
Practice Address - Zip Code:21794-9543
Practice Address - Country:US
Practice Address - Phone:901-288-3223
Practice Address - Fax:410-531-1252
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD195011835P0018X
AL184141835P0018X
AZS0205201835P0018X
GARPH0282941835P0018X
KY173251835P0018X
LA154451835P0018X
MI53020435071835P0018X
MST135061835P0018X
NV182041835P0018X
OK160981835P0018X
ORRPH00140931835P0018X
SC136381835P0018X
VA002022129101835P0018X
WVRPH00083961835P0018X
TX581861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist