Provider Demographics
NPI:1497080337
Name:BLANCHARD, BRET EGBERT (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:EGBERT
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2648
Mailing Address - Country:US
Mailing Address - Phone:480-892-2217
Mailing Address - Fax:480-813-6892
Practice Address - Street 1:3751 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2648
Practice Address - Country:US
Practice Address - Phone:480-892-2217
Practice Address - Fax:480-813-6892
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11152183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist