Provider Demographics
NPI:1285047118
Name:BLANNER, ROBERT CHARLES III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:BLANNER
Suffix:III
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 1:725 LYSLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132
Mailing Address - Country:US
Mailing Address - Phone:412-672-3853
Mailing Address - Fax:412-672-5582
Practice Address - Street 1:725 LYSLE BLVD
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-672-3853
Practice Address - Fax:412-672-5582
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist