Provider Demographics
NPI:1215538046
Name:BLUE, NANCY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:BLUE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 DENVALE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1208
Mailing Address - Country:US
Mailing Address - Phone:217-799-0548
Mailing Address - Fax:
Practice Address - Street 1:4101 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-5997
Practice Address - Country:US
Practice Address - Phone:217-443-9587
Practice Address - Fax:217-443-9553
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.034001183500000X
IN26013736A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist