Provider Demographics
NPI:1013049428
Name:BLUMENSCHEIN, GAYNELL L (RPH)
Entity Type:Individual
Prefix:MS
First Name:GAYNELL
Middle Name:L
Last Name:BLUMENSCHEIN
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 1:13175 DAVISBURG RD
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2412
Mailing Address - Country:US
Mailing Address - Phone:248-634-9231
Mailing Address - Fax:
Practice Address - Street 1:6625 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3422
Practice Address - Country:US
Practice Address - Phone:248-620-6680
Practice Address - Fax:248-620-8705
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist