Provider Demographics
NPI:1508088352
Name:BLOUNT, VIRGINIA BRYANT (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BRYANT
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1430
Mailing Address - Country:US
Mailing Address - Phone:205-967-3009
Mailing Address - Fax:
Practice Address - Street 1:60 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-3734
Practice Address - Country:US
Practice Address - Phone:205-871-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist