Provider Demographics
NPI:1912287491
Name:BLOUNT, REBEKAH LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:LOUISE
Last Name:BLOUNT
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 1:918 W MERCURY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4323
Mailing Address - Country:US
Mailing Address - Phone:757-262-2188
Mailing Address - Fax:757-262-1138
Practice Address - Street 1:918 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4323
Practice Address - Country:US
Practice Address - Phone:757-262-2188
Practice Address - Fax:757-262-1138
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202209183OtherLICENSE