Provider Demographics
NPI:1407960032
Name:BLACKWELL, STEVEN ALLEN (PHD, JD, RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALLEN
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:PHD, JD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 KINGS MILL WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6601
Mailing Address - Country:US
Mailing Address - Phone:443-394-0591
Mailing Address - Fax:
Practice Address - Street 1:7500 SECURITY BLVD # C3-20-17
Practice Address - Street 2:CENTERS FOR MEDICARE & MEDICAID SERVICES
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1849
Practice Address - Country:US
Practice Address - Phone:410-786-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15124183500000X
TN6081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist