Provider Demographics
NPI:1043590599
Name:BLASDEL, JEFF E (RPH)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:E
Last Name:BLASDEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W JONATHAN MOORE PIKE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-9455
Mailing Address - Country:US
Mailing Address - Phone:812-378-0804
Mailing Address - Fax:812-378-2078
Practice Address - Street 1:2140 W JONATHAN MOORE PIKE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-9455
Practice Address - Country:US
Practice Address - Phone:812-378-0804
Practice Address - Fax:812-378-2078
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014238A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist