Provider Demographics
NPI:1750024592
Name:BLOUGH, BRIAN WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:BLOUGH
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 1:16845 HURON ST APT 3-202
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8944
Mailing Address - Country:US
Mailing Address - Phone:864-316-4919
Mailing Address - Fax:
Practice Address - Street 1:40 COUNTY ROAD 804
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:CO
Practice Address - Zip Code:80442-5001
Practice Address - Country:US
Practice Address - Phone:970-726-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0023871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist