Individual
MR. KRISTOPHER BRENT BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
801 BENTON RD, BOSSIER CITY, LA 71111
(318) 742-3509
(318) 742-7730
Mailing address
801 BENTON RD, BOSSIER CITY, LA 71111-3743
(318) 742-3509
(318) 742-7730
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15947
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA 15947
PHARMACIST LA 15947
LA
Enumeration date
08/29/2013
Last updated
08/29/2013
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