Provider Demographics
NPI:1053667030
Name:BLANCHE, EDWIN G (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:G
Last Name:BLANCHE
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-0005
Mailing Address - Country:US
Mailing Address - Phone:318-766-4563
Mailing Address - Fax:318-766-4522
Practice Address - Street 1:705 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:LA
Practice Address - Zip Code:71366
Practice Address - Country:US
Practice Address - Phone:318-766-4563
Practice Address - Fax:318-766-4522
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist