Provider Demographics
NPI:1831140763
Name:BLAIR, STEPHEN BRIAN (CPHT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRIAN
Last Name:BLAIR
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 IDAHO ST
Mailing Address - Street 2:APT #2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1952
Mailing Address - Country:US
Mailing Address - Phone:907-677-0680
Mailing Address - Fax:
Practice Address - Street 1:1217 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4003
Practice Address - Country:US
Practice Address - Phone:907-257-4691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK527183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician