Provider Demographics
NPI:1619571312
Name:BLANKENSHIP, JIMMY DOUGLAS (PHARMD, PHD)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DOUGLAS
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 KY HWY 36E
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031
Mailing Address - Country:US
Mailing Address - Phone:859-234-2300
Mailing Address - Fax:859-235-3604
Practice Address - Street 1:1210 KY HWY 36E
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031
Practice Address - Country:US
Practice Address - Phone:859-234-2300
Practice Address - Fax:859-235-3604
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist