Provider Demographics
NPI:1073244497
Name:BLANKINCHIP, STEPHEN DALE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DALE
Last Name:BLANKINCHIP
Suffix:JR
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 1:2507 MARKET TRCE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8677
Mailing Address - Country:US
Mailing Address - Phone:479-646-5505
Mailing Address - Fax:479-649-9535
Practice Address - Street 1:2507 MARKET TRCE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8677
Practice Address - Country:US
Practice Address - Phone:479-646-5505
Practice Address - Fax:479-649-9535
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist