Provider Demographics
NPI:1851019475
Name:BLACKERBY, FEDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FEDRA
Middle Name:
Last Name:BLACKERBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4306
Mailing Address - Country:US
Mailing Address - Phone:630-892-9075
Mailing Address - Fax:
Practice Address - Street 1:1952 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4306
Practice Address - Country:US
Practice Address - Phone:630-892-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist