Provider Demographics
NPI:1235458639
Name:BLESSMAN, MICHAEL REUSS (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:REUSS
Last Name:BLESSMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2670
Mailing Address - Country:US
Mailing Address - Phone:309-647-0884
Mailing Address - Fax:309-647-0893
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2670
Practice Address - Country:US
Practice Address - Phone:309-647-0884
Practice Address - Fax:309-647-0893
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist