Provider Demographics
NPI:1821380742
Name:BLYTHE, DAVID S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:BLYTHE
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 1:4237 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5238
Mailing Address - Country:US
Mailing Address - Phone:215-222-2440
Mailing Address - Fax:215-222-2442
Practice Address - Street 1:3300 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1601
Practice Address - Country:US
Practice Address - Phone:215-624-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist