Provider Demographics
NPI:1336458181
Name:BLAIR, BENJAMIN WALTER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WALTER
Last Name:BLAIR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 HILLSDALE LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3889
Mailing Address - Country:US
Mailing Address - Phone:210-213-9562
Mailing Address - Fax:
Practice Address - Street 1:11022 HILLSDALE LOOP
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3889
Practice Address - Country:US
Practice Address - Phone:210-213-9562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417281835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric