Provider Demographics
NPI:1710371026
Name:BLENHEIM PHARMACAL, INC.
Entity Type:Organization
Organization Name:BLENHEIM PHARMACAL, INC.
Other - Org Name:BLENHEIM PHARMACAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-827-3121
Mailing Address - Street 1:119 CREAMERY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BLENHEIM
Mailing Address - State:NY
Mailing Address - Zip Code:12131-1613
Mailing Address - Country:US
Mailing Address - Phone:518-827-3121
Mailing Address - Fax:866-223-8434
Practice Address - Street 1:119 CREAMERY RD
Practice Address - Street 2:
Practice Address - City:NORTH BLENHEIM
Practice Address - State:NY
Practice Address - Zip Code:12131-1613
Practice Address - Country:US
Practice Address - Phone:518-827-3121
Practice Address - Fax:866-223-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0268933336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150961OtherPK