Provider Demographics
NPI:1295168128
Name:BLACKWELL, CHRISTIE LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LEE
Last Name:BLACKWELL
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 1:192 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8101
Mailing Address - Country:US
Mailing Address - Phone:706-635-2241
Mailing Address - Fax:706-635-2246
Practice Address - Street 1:192 1ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8101
Practice Address - Country:US
Practice Address - Phone:706-635-2241
Practice Address - Fax:706-635-2246
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist