Provider Demographics
NPI:1326227000
Name:ALBERTY, JOHN BLAINE (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BLAINE
Last Name:ALBERTY
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 1:1001 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2121
Mailing Address - Country:US
Mailing Address - Phone:573-777-7301
Mailing Address - Fax:573-777-7335
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2121
Practice Address - Country:US
Practice Address - Phone:573-777-7301
Practice Address - Fax:573-777-7335
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist