Provider Demographics
NPI:1881369759
Name:BLANKENSHIP, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BLANKENSHIP
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 1:858 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:GA
Mailing Address - Zip Code:31824-4122
Mailing Address - Country:US
Mailing Address - Phone:229-389-1887
Mailing Address - Fax:
Practice Address - Street 1:6381 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:GA
Practice Address - Zip Code:31824-4029
Practice Address - Country:US
Practice Address - Phone:229-828-2773
Practice Address - Fax:229-828-2115
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist