Provider Demographics
NPI:1447203245
Name:BLAIR, BRIAN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:BLAIR
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 1:6824 FRANKEN STRASSE
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260
Mailing Address - Country:US
Mailing Address - Phone:618-476-9050
Mailing Address - Fax:618-476-1709
Practice Address - Street 1:120 W WASHINGTON
Practice Address - Street 2:
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260
Practice Address - Country:US
Practice Address - Phone:618-476-1701
Practice Address - Fax:618-476-1709
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist