Provider Demographics
NPI:1275106668
Name:BLANKS, KENNETH EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:BLANKS
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 1:6311 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9365
Mailing Address - Country:US
Mailing Address - Phone:330-703-7988
Mailing Address - Fax:
Practice Address - Street 1:3975 EMBASSY PKWY STE A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8319
Practice Address - Country:US
Practice Address - Phone:330-379-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03218125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist