Provider Demographics
NPI:1679203004
Name:BIANCHI, VIVIAN GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:GRACE
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:GRACE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY INTERN
Mailing Address - Street 1:3104 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1827
Mailing Address - Country:US
Mailing Address - Phone:859-426-0342
Mailing Address - Fax:859-426-0379
Practice Address - Street 1:3104 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1827
Practice Address - Country:US
Practice Address - Phone:859-426-0342
Practice Address - Fax:859-426-0379
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224561183500000X
KY012214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03224561OtherOHIO STATE BOARD OF PHARMACY
KY012214OtherKENTUCKY BOARD OF PHARMACY