DR. RUSSELL MARION BLAYLOCK (NPI# 1477584704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477584704 |
| Entity Type | Individual |
| Full Name | DR. RUSSELL MARION BLAYLOCK |
| Credential | PHARMD |
| Practice Address |
751 Cromwell Avenue Clovis CA 93611 |
| Mailing Address |
751 Cromwell Ave Clovis CA 93611-7027 |
| Practice Telephone | 5596817876 |
| Mailing Telephone | 5596817876 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 12607-040 | WI | Pharmacy Service Providers |
| Street Address |
751 CROMWELL AVENUE |
| City | CLOVIS |
| State | CA |
| Zip Code | 93611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033773122 | Mao Thao | Pharmacist | 2133 Shaw Avenue, Clovis, CA 93611 | 2019-04-24 |
| 1326506098 | Lauren Moriah Horsley | Speech-Language Pathologist | 650 W. Alluvial Ave., Clovis, CA 93611 | 2019-03-12 |
| 1780171223 | Alamos Care | Skilled Nursing Facility | 2193 Alamos Ave, Clovis, CA 93611 | 2018-04-19 |
| 1346612215 | Aimee Rasch | Occupational Therapy Assistant | 650 West Alluvial Avenue, Clovis, CA 93611 | 2015-10-30 |
| 1356778302 | Jonathan Crosby | Physician Assistant | 729 N Medical Center Drive West Suite 101, Clovis, CA 93611 | 2013-10-07 |
| 1093142697 | Stacey Melissa Montes | Nurse Practitioner | 729 N Medical Ctr Dr West, Suite 205, Clovis, CA 93611 | 2013-09-27 |
| 1538594163 | Carly Bren Lepp | Physician Assistant | 2006 Shaw Avenue, Clovis, CA 93611 | 2013-09-13 |
| 1811246150 | Vishal Arya | Pharmacist | 2518 Austin Ave, Clovis, CA 93611 | 2012-08-31 |
| 1669757209 | Kiran V Atwal | Pharmacist | 1815 Herndon Ave--walgreens, Clovis, CA 93611 | 2011-10-14 |
| 1952615957 | Weight Away | Nutritionist | 1895 Herndon Ave, Suite 105, Clovis, CA 93611 | 2010-08-02 |
| Find all providers in zip 93611 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730791260 | Gabriela Dutra-clarke | Pharmacist | 1712 Burgan Ave, Clovis, CA 93611-3158 | 2020-08-17 |
| 1285254045 | Inga Sarkisian | Pharmacist | 3445 Amanecer Ave, Clovis, CA 93619-5189 | 2020-04-22 |
| 1952932923 | Tia Tang | Pharmacist | 12246 N Via Piemonte Ave, Clovis, CA 93619-8389 | 2020-01-29 |
| 1235798695 | Lien Nguyen | Pharmacist | 3522 Smith Ln, Clovis, CA 93619-4311 | 2019-06-10 |
| 1033773122 | Mao Thao | Pharmacist | 2133 Shaw Avenue, Clovis, CA 93611 | 2019-04-24 |
| 1518449289 | Colton Ray Dant | Pharmacist | 2401 W 21st St, Clovis, NM 88101-2006 | 2018-08-30 |
| 1407369275 | Tony Minh Ta | Pharmacist | 159 W Shaw Ave, Clovis, CA 93612-3726 | 2017-11-14 |
| 1023521291 | Mei Feng Guan | Pharmacist | 745 N Fowler Ave Apt 230, Clovis, CA 93611-6876 | 2017-11-10 |
| 1659809507 | Allen Keshishian Namagerdi | Pharmacist | 111 W 9th St Apt 272, Clovis, CA 93612-1734 | 2017-05-23 |
| 1417482464 | Tiffanie Guy | Pharmacist | 2810 Willow Ave Apt 206, Clovis, CA 93612 | 2017-04-27 |
| Find all providers in CLOVIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.