Provider Demographics
NPI:1831274919
Name:BLACKBURN, ANITA FAYE
Entity type:Individual
Prefix:MR
First Name:ANITA
Middle Name:FAYE
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 1:3401 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1734
Mailing Address - Country:US
Mailing Address - Phone:806-741-3433
Mailing Address - Fax:806-741-3778
Practice Address - Street 1:3401 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1734
Practice Address - Country:US
Practice Address - Phone:806-741-3433
Practice Address - Fax:806-741-3778
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15705183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician