Provider Demographics
NPI:1649226887
Name:BLANCHARD, RUSSELL EDWIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EDWIN
Last Name:BLANCHARD
Suffix:JR
Gender:M
Credentials:RPH
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Mailing Address - Street 1:2212 GLENDALE RD
Mailing Address - Street 2:COUNTRY CLUB HILLS
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3434
Mailing Address - Country:US
Mailing Address - Phone:706-733-2495
Mailing Address - Fax:706-733-2497
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:114-U
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-733-2495
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GARPH009429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist