Provider Demographics
NPI:1164737250
Name:BLANKENSHIP, RANDY R (DPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3279
Mailing Address - Country:US
Mailing Address - Phone:423-485-1238
Mailing Address - Fax:423-855-3006
Practice Address - Street 1:7804 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3279
Practice Address - Country:US
Practice Address - Phone:423-485-1238
Practice Address - Fax:423-855-3006
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist