Provider Demographics
NPI:1427490010
Name:BLOMQUIST, JAMES SIDNEY (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SIDNEY
Last Name:BLOMQUIST
Suffix:
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 1:2430 TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2245
Mailing Address - Country:US
Mailing Address - Phone:209-765-1616
Mailing Address - Fax:
Practice Address - Street 1:6331 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9646
Practice Address - Country:US
Practice Address - Phone:209-869-9055
Practice Address - Fax:209-869-9057
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist