Provider Demographics
NPI:1982908570
Name:BLATT, MEGHAN AM
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:AM
Last Name:BLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9016 BREVET LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-6591
Mailing Address - Country:US
Mailing Address - Phone:804-513-3028
Mailing Address - Fax:804-569-8243
Practice Address - Street 1:9351 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2540
Practice Address - Country:US
Practice Address - Phone:804-569-8241
Practice Address - Fax:804-569-8243
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0202207127OtherPHARMACIST LICENSE