Provider Demographics
NPI:1063919710
Name:BLINK HEALTH PHARMACY LLC
Entity type:Organization
Organization Name:BLINK HEALTH PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-266-5515
Mailing Address - Street 1:400 S WOODS MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3427
Mailing Address - Country:US
Mailing Address - Phone:314-356-2943
Mailing Address - Fax:314-558-2641
Practice Address - Street 1:400 S WOODS MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3427
Practice Address - Country:US
Practice Address - Phone:314-356-2943
Practice Address - Fax:314-558-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20180115413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018011541OtherMISSOURI BOARD OF PHARMACY