Provider Demographics
NPI:1891302154
Name:SCHUMACHER, BLAKE ANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ANTHONY
Last Name:SCHUMACHER
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 1:7602 AMBERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7864
Mailing Address - Country:US
Mailing Address - Phone:208-503-0224
Mailing Address - Fax:
Practice Address - Street 1:5001 N TEN MILE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6515
Practice Address - Country:US
Practice Address - Phone:208-982-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist