Provider Demographics
NPI:1821352311
Name:BLACKFORD, JAMESON TANNER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMESON
Middle Name:TANNER
Last Name:BLACKFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TANNER
Other - Middle Name:
Other - Last Name:BLACKFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7 AMAZON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6219
Mailing Address - Country:US
Mailing Address - Phone:660-853-9364
Mailing Address - Fax:
Practice Address - Street 1:700 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4373
Practice Address - Country:US
Practice Address - Phone:573-442-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist