Provider Demographics
NPI:1548319189
Name:BLACKBURN, THOMAS JOBE
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOBE
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1029
Mailing Address - Country:US
Mailing Address - Phone:724-226-9482
Mailing Address - Fax:724-224-9462
Practice Address - Street 1:1211 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1029
Practice Address - Country:US
Practice Address - Phone:724-226-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040025L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist