Provider Demographics
NPI:1275800476
Name:BLANCHARD, JAY C (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:BLANCHARD
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 1:4535 W MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-4841
Mailing Address - Country:US
Mailing Address - Phone:414-541-6324
Mailing Address - Fax:
Practice Address - Street 1:W156N11261 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3420
Practice Address - Country:US
Practice Address - Phone:262-253-9720
Practice Address - Fax:262-253-1734
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10497-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist