Provider Demographics
NPI:1699097865
Name:BLITZBLAU, BENJAMIN DAVID (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:BLITZBLAU
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Gender:M
Credentials:PHARMD
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Mailing Address - Street 1:1515 E RIVERSIDE BLVD
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4742
Mailing Address - Country:US
Mailing Address - Phone:815-877-8059
Mailing Address - Fax:815-282-4992
Practice Address - Street 1:1515 E RIVERSIDE BLVD
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4742
Practice Address - Country:US
Practice Address - Phone:815-877-8059
Practice Address - Fax:815-282-4992
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
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Provider Licenses
StateLicense IDTaxonomies
IL0512900771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy