Provider Demographics
NPI:1598765752
Name:HINRICHS, BLAINE E (RPH)
Entity Type:Individual
Prefix:MR
First Name:BLAINE
Middle Name:E
Last Name:HINRICHS
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:W7920 390TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-8209
Mailing Address - Country:US
Mailing Address - Phone:715-792-2445
Mailing Address - Fax:
Practice Address - Street 1:499 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2330
Practice Address - Country:US
Practice Address - Phone:651-917-2001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115027-6183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist