Provider Demographics
NPI:1720503600
Name:BLACKBURN, RACHEL KENDRA
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:KENDRA
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 STATE HIGHWAY 1056
Mailing Address - Street 2:
Mailing Address - City:MC CARR
Mailing Address - State:KY
Mailing Address - Zip Code:41544-8309
Mailing Address - Country:US
Mailing Address - Phone:606-625-6201
Mailing Address - Fax:
Practice Address - Street 1:11349 STATE HIGHWAY 1056
Practice Address - Street 2:
Practice Address - City:MC CARR
Practice Address - State:KY
Practice Address - Zip Code:41544
Practice Address - Country:US
Practice Address - Phone:606-427-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist