Provider Demographics
NPI:1356439418
Name:BLOMQUIST, ROBERT LOUIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:BLOMQUIST
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 1:146 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2810
Mailing Address - Country:US
Mailing Address - Phone:805-643-9939
Mailing Address - Fax:
Practice Address - Street 1:146 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2810
Practice Address - Country:US
Practice Address - Phone:805-643-9939
Practice Address - Fax:805-658-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist