Provider Demographics
NPI:1033832100
Name:BLANKENSHIP, RICHARD BRENT (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRENT
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 E DOUGLAS AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3525
Mailing Address - Country:US
Mailing Address - Phone:251-610-1555
Mailing Address - Fax:
Practice Address - Street 1:3149 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4016
Practice Address - Country:US
Practice Address - Phone:316-686-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55790183500000X
KS1-108018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist