Provider Demographics
NPI:1952404089
Name:GENE BLOUNT
Entity type:Organization
Organization Name:GENE BLOUNT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-269-3922
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:JOAQUIN
Mailing Address - State:TX
Mailing Address - Zip Code:75954-0506
Mailing Address - Country:US
Mailing Address - Phone:936-269-3922
Mailing Address - Fax:936-269-9809
Practice Address - Street 1:13290 HWY 84 E
Practice Address - Street 2:
Practice Address - City:JOAQUIN
Practice Address - State:TX
Practice Address - Zip Code:75954-0506
Practice Address - Country:US
Practice Address - Phone:936-269-3922
Practice Address - Fax:936-269-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX48733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1274321Medicaid
TX141708Medicaid
2097960OtherPK
0778970001Medicare NSC