Provider Demographics
NPI:1770668170
Name:BLACKHAM, DAVID HOWARD (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
Last Name:BLACKHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N 300 E
Mailing Address - Street 2:NBU 87
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1409
Mailing Address - Country:US
Mailing Address - Phone:435-462-3476
Mailing Address - Fax:435-462-3400
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1327
Practice Address - Country:US
Practice Address - Phone:435-462-2434
Practice Address - Fax:435-462-3400
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT148100-1701183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric