Provider Demographics
NPI:1992004139
Name:MACBLAIN, BECKY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:MACBLAIN
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 1:146 N CORNING ST
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9737
Mailing Address - Country:US
Mailing Address - Phone:989-588-2599
Mailing Address - Fax:989-588-3024
Practice Address - Street 1:146 N CORNING ST
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9737
Practice Address - Country:US
Practice Address - Phone:989-588-2599
Practice Address - Fax:989-588-3024
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist