Provider Demographics
NPI:1255606182
Name:BLACKWELL, MEISHA LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MEISHA
Middle Name:LYNNE
Last Name:BLACKWELL
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 1:3276 ELGIN DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2208
Mailing Address - Country:US
Mailing Address - Phone:801-907-8153
Mailing Address - Fax:
Practice Address - Street 1:771 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1639
Practice Address - Country:US
Practice Address - Phone:734-213-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333206-1701183500000X
MI53020421761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist