Provider Demographics
NPI:1982834503
Name:BLENSKI, REBECCA LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BLENSKI
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 1:801 TONAWANDA STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207
Mailing Address - Country:US
Mailing Address - Phone:716-875-1090
Mailing Address - Fax:716-875-7806
Practice Address - Street 1:801 TONAWANDA STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207
Practice Address - Country:US
Practice Address - Phone:716-875-1090
Practice Address - Fax:716-875-7806
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01819089Medicaid