Provider Demographics
NPI:1477973832
Name:DEBLAQUIERE ENTERPRISES INC
Entity Type:Organization
Organization Name:DEBLAQUIERE ENTERPRISES INC
Other - Org Name:WHITE CROSS PHARMACY - SPIRIT LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DE BLAQUIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-610-0752
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-0510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31964 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869
Practice Address - Country:US
Practice Address - Phone:208-623-8485
Practice Address - Fax:208-623-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1477973832Medicaid