Provider Demographics
NPI:1396057170
Name:BLOSSER, MARK JAMES (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:BLOSSER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 FERRY RD.
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-609-4074
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2535
Practice Address - Country:US
Practice Address - Phone:865-471-0548
Practice Address - Fax:865-471-5103
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000027206183500000X
OH03323815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist