Provider Demographics
NPI:1992134571
Name:BLOMEKE, BENJAMIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BLOMEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8937
Mailing Address - Country:US
Mailing Address - Phone:269-384-9505
Mailing Address - Fax:
Practice Address - Street 1:6405 B DR N
Practice Address - Street 2:MEIJER PHARMACY, STORE 195
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-7573
Practice Address - Country:US
Practice Address - Phone:269-979-6610
Practice Address - Fax:269-979-6665
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020325231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy