Provider Demographics
NPI:1689751794
Name:BLANKE, ROBERT GALEN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GALEN
Last Name:BLANKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24903 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-7234
Mailing Address - Country:US
Mailing Address - Phone:913-727-6118
Mailing Address - Fax:
Practice Address - Street 1:429 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2732
Practice Address - Country:US
Practice Address - Phone:913-682-1602
Practice Address - Fax:913-682-4220
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist