Provider Demographics
NPI:1972892099
Name:BLACKWELL, NANCY TIMMERMAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:TIMMERMAN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 NEW WAVERLY PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-1609
Mailing Address - Country:US
Mailing Address - Phone:919-851-3301
Mailing Address - Fax:919-852-1658
Practice Address - Street 1:575 NEW WAVERLY PL
Practice Address - Street 2:SUITE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1609
Practice Address - Country:US
Practice Address - Phone:919-851-3301
Practice Address - Fax:919-852-1658
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7654183500000X
SC5275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist