Provider Demographics
NPI:1124693585
Name:BLANTON, ALEXANDER GRAY SR (RPH)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:GRAY
Last Name:BLANTON
Suffix:SR
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 1:409 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2115
Mailing Address - Country:US
Mailing Address - Phone:540-635-2249
Mailing Address - Fax:
Practice Address - Street 1:234 WALNUT DR
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2349
Practice Address - Country:US
Practice Address - Phone:540-635-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist