Provider Demographics
NPI:1679987002
Name:BLITZ, AUDREY PAULETTE (RPH)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:PAULETTE
Last Name:BLITZ
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 1:7025 YELLOWSTONE BLVD
Mailing Address - Street 2:APT 6D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3164
Mailing Address - Country:US
Mailing Address - Phone:718-263-1856
Mailing Address - Fax:
Practice Address - Street 1:7025 YELLOWSTONE BLVD
Practice Address - Street 2:APT 6D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3164
Practice Address - Country:US
Practice Address - Phone:718-263-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist