Provider Demographics
NPI:1245780790
Name:BLEVINS, AARON (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-1440
Mailing Address - Country:US
Mailing Address - Phone:417-724-2601
Mailing Address - Fax:417-724-2621
Practice Address - Street 1:105 S RIDGECREST AVE STE 1&2
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7807
Practice Address - Country:US
Practice Address - Phone:417-724-2601
Practice Address - Fax:417-724-2621
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist