Provider Demographics
NPI:1235701293
Name:BLYUMIN, MICHAEL GREGORY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREGORY
Last Name:BLYUMIN
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 1:854 JORDAN AVE APT K
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1422
Mailing Address - Country:US
Mailing Address - Phone:619-339-2394
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR RM H0301C
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-493-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist