Provider Demographics
NPI:1881146231
Name:BLANTON, TODD ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ROBERT
Last Name:BLANTON
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 1:415 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6468
Mailing Address - Country:US
Mailing Address - Phone:573-499-1933
Mailing Address - Fax:
Practice Address - Street 1:415 CONLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6468
Practice Address - Country:US
Practice Address - Phone:573-499-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016034040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist