Provider Demographics
NPI:1437766003
Name:BLALOCK, TARYN ALIA (CPHT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:ALIA
Last Name:BLALOCK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:DEANNE
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:1013 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1274
Mailing Address - Country:US
Mailing Address - Phone:909-745-3906
Mailing Address - Fax:
Practice Address - Street 1:10530 JOHN W ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-2013
Practice Address - Country:US
Practice Address - Phone:800-424-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230363183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician