Provider Demographics
NPI:1407005531
Name:BLACKWELL, KACEE ERIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KACEE
Middle Name:ERIN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 RIVA RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-0834
Mailing Address - Country:US
Mailing Address - Phone:405-269-6289
Mailing Address - Fax:
Practice Address - Street 1:3000 E MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7000
Practice Address - Country:US
Practice Address - Phone:405-697-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist