Provider Demographics
NPI:1609328939
Name:BARNES, BLAINE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2929
Mailing Address - Country:US
Mailing Address - Phone:970-824-4449
Mailing Address - Fax:
Practice Address - Street 1:505 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2929
Practice Address - Country:US
Practice Address - Phone:970-824-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist