Provider Demographics
NPI:1629342936
Name:BLANK, ANN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:BLANK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1360 DOLWICK DRIVE
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3159
Practice Address - Country:US
Practice Address - Phone:859-344-5555
Practice Address - Fax:859-344-5552
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist