Provider Demographics
NPI:1093302333
Name:BLANKENSHIP, HALEY LAKIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LAKIN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CECIL LN
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9565
Mailing Address - Country:US
Mailing Address - Phone:502-460-0777
Mailing Address - Fax:
Practice Address - Street 1:805 BARDSTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1514
Practice Address - Country:US
Practice Address - Phone:859-336-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029095A183500000X
KY021813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist