Provider Demographics
NPI:1346564531
Name:BLAU, PAMELA MERYL (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MERYL
Last Name:BLAU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 OCEAN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3545
Mailing Address - Country:US
Mailing Address - Phone:516-766-8915
Mailing Address - Fax:516-255-0103
Practice Address - Street 1:3287 OCEAN HARBOR DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3545
Practice Address - Country:US
Practice Address - Phone:516-766-8915
Practice Address - Fax:516-255-0103
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist