Provider Demographics
NPI:1588001911
Name:BLITSTEIN, RAYMOND EARL
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EARL
Last Name:BLITSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16748 E SMOKY HILL RD
Mailing Address - Street 2:SUITE C-128
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2495
Mailing Address - Country:US
Mailing Address - Phone:303-489-1711
Mailing Address - Fax:303-627-1935
Practice Address - Street 1:167848 E. SMOKY HILL ROAD
Practice Address - Street 2:SUITE C-128
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015
Practice Address - Country:US
Practice Address - Phone:303-489-1711
Practice Address - Fax:303-627-1935
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist