Provider Demographics
NPI:1912223942
Name:BLACKWELL, JANE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:BLACKWELL
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 1:3555 OLD US HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-7035
Mailing Address - Country:US
Mailing Address - Phone:910-654-3350
Mailing Address - Fax:910-628-9059
Practice Address - Street 1:414 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-2038
Practice Address - Country:US
Practice Address - Phone:910-628-6068
Practice Address - Fax:910-628-9059
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist