Provider Demographics
NPI:1093702227
Name:DE BLAQUIERE, RICHARD ALLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLAN
Last Name:DE BLAQUIERE
Suffix:
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 1:702 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-9023
Mailing Address - Country:US
Mailing Address - Phone:208-263-9080
Mailing Address - Fax:208-255-1695
Practice Address - Street 1:5453 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856
Practice Address - Country:US
Practice Address - Phone:208-448-1633
Practice Address - Fax:208-448-1728
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist