Provider Demographics
NPI:1710583968
Name:BLODGETT, CHANDLER S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:S
Last Name:BLODGETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1931
Mailing Address - Country:US
Mailing Address - Phone:207-236-9006
Mailing Address - Fax:207-236-9010
Practice Address - Street 1:6 GLEN COVE DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-1931
Practice Address - Country:US
Practice Address - Phone:207-301-8585
Practice Address - Fax:207-301-8574
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist