Provider Demographics
NPI:1669761375
Name:BLOMSTEDT, DEEPA H (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:H
Last Name:BLOMSTEDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHAPMAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5400
Mailing Address - Country:US
Mailing Address - Phone:401-384-0320
Mailing Address - Fax:
Practice Address - Street 1:117 CHAPMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5400
Practice Address - Country:US
Practice Address - Phone:401-384-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist