Provider Demographics
NPI:1841806494
Name:DEBLAQUIERE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:DEBLAQUIERE ENTERPRISES, INC.
Other - Org Name:WHITE CROSS PHARMACY - OLDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DE BLAQUIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-610-0752
Mailing Address - Street 1:PO BOX 3525
Mailing Address - Street 2:
Mailing Address - City:OLDTOWN
Mailing Address - State:ID
Mailing Address - Zip Code:83822-3525
Mailing Address - Country:US
Mailing Address - Phone:208-457-7160
Mailing Address - Fax:208-369-4553
Practice Address - Street 1:86 TANK RD
Practice Address - Street 2:
Practice Address - City:OLDTOWN
Practice Address - State:ID
Practice Address - Zip Code:83822-5126
Practice Address - Country:US
Practice Address - Phone:208-457-7160
Practice Address - Fax:208-369-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1841806494Medicaid