Provider Demographics
NPI:1740880319
Name:BLANKENSHIP, MONICA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:BLANKENSHIP
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 1:12235 GRAPEFIELD RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BASTIAN
Mailing Address - State:VA
Mailing Address - Zip Code:24314-4623
Mailing Address - Country:US
Mailing Address - Phone:276-688-2424
Mailing Address - Fax:276-688-2355
Practice Address - Street 1:12235 GRAPEFIELD RD UNIT 1
Practice Address - Street 2:
Practice Address - City:BASTIAN
Practice Address - State:VA
Practice Address - Zip Code:24314-4623
Practice Address - Country:US
Practice Address - Phone:276-688-2424
Practice Address - Fax:276-688-2355
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist