Individual
MR. BENJAMIN DAVID BLITZBLAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1515 E RIVERSIDE BLVD, KMART PHARMACY, LOVES PARK, IL 61111-4742
(815) 877-8059
(815) 282-4992
Mailing address
1515 E RIVERSIDE BLVD, KMART PHARMACY, LOVES PARK, IL 61111-4742
(815) 877-8059
(815) 282-4992
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
051290077
IL
Other
Enumeration date
02/15/2010
Last updated
02/15/2010
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