Individual
MR. GLEN RUSSEL BLACKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
(419) 562-4222
(419) 562-4516
Mailing address
345 N SANDUSKY AVE, BUCYRUS, OH 44820-1806
(419) 562-4222
(419) 562-4516
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03109939
OH
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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