Provider Demographics
NPI:1376843144
Name:BLANKENSHIP, MICHAEL STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:BLANKENSHIP
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 1:4320 SE KING RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-5281
Mailing Address - Country:US
Mailing Address - Phone:503-659-1840
Mailing Address - Fax:
Practice Address - Street 1:4320 SE KING RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-5281
Practice Address - Country:US
Practice Address - Phone:503-659-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist