Provider Demographics
NPI:1194320127
Name:BLASDEL, NATHAN ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ANDREW
Last Name:BLASDEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 COUNTY ROAD 1350 N
Mailing Address - Street 2:
Mailing Address - City:WAYNE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62895-0420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 W JOURDAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1930
Practice Address - Country:US
Practice Address - Phone:618-783-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist