Provider Demographics
NPI:1720194921
Name:BLAUVELT, RICHARD A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BLAUVELT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 OAK BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3065
Mailing Address - Country:US
Mailing Address - Phone:317-865-6753
Mailing Address - Fax:317-865-6832
Practice Address - Street 1:8820 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6056
Practice Address - Country:US
Practice Address - Phone:317-865-6833
Practice Address - Fax:317-865-6832
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014909A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26014909AOtherPHARMACIST LICENSE NUMBER