Provider Demographics
NPI:1871119115
Name:BLOSSER, KATELIND A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATELIND
Middle Name:A
Last Name:BLOSSER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9613
Mailing Address - Country:US
Mailing Address - Phone:330-605-7775
Mailing Address - Fax:
Practice Address - Street 1:705 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2057
Practice Address - Country:US
Practice Address - Phone:330-339-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist