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Individual
ROGER D BLACKWELL
Active
Individual
ROGER D BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
8717
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8717
SC PHARMACIST IN CHARGE
SC
Enumeration date
06/22/2006
Last updated
07/08/2007
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