Provider Demographics
NPI:1629247903
Name:BLUM, DALE FISCHER (RPH)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:FISCHER
Last Name:BLUM
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 1:30 POLDER DR
Mailing Address - Street 2:
Mailing Address - City:UPPER HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1522
Mailing Address - Country:US
Mailing Address - Phone:215-741-0147
Mailing Address - Fax:215-741-3540
Practice Address - Street 1:8716 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19136-1315
Practice Address - Country:US
Practice Address - Phone:215-331-0200
Practice Address - Fax:215-338-7788
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028959L183500000X
PAPP411788L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist