Individual
DUSTIN BRADLEY BLALOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
340 NORMAN DR, VALDOSTA, GA 31601-7713
(479) 322-2051
Mailing address
642 RUBEN RD, BYRON, GA 31008-5990
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH026684
GA
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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