Provider Demographics
NPI:1699814087
Name:BLACKSTONE, REBECCA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BLACKSTONE
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 1:202 ECHO VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2111
Mailing Address - Country:US
Mailing Address - Phone:830-775-0704
Mailing Address - Fax:830-775-0704
Practice Address - Street 1:913 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5807
Practice Address - Country:US
Practice Address - Phone:830-774-5534
Practice Address - Fax:830-774-2714
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX025708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist