Provider Demographics
NPI:1023318250
Name:BLIZZARD, WESLEY (RPH)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78210 VARNER RD
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-4134
Mailing Address - Country:US
Mailing Address - Phone:760-772-2764
Mailing Address - Fax:760-772-2783
Practice Address - Street 1:78210 VARNER RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4134
Practice Address - Country:US
Practice Address - Phone:760-772-2764
Practice Address - Fax:760-772-2783
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist