Provider Demographics
NPI:1265620983
Name:BLUM, SHAUN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LARRABEE AVE
Mailing Address - Street 2:STE 104-309
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7367
Mailing Address - Country:US
Mailing Address - Phone:480-747-3030
Mailing Address - Fax:602-391-2727
Practice Address - Street 1:1050 LARRABEE AVE
Practice Address - Street 2:STE 104-309
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7367
Practice Address - Country:US
Practice Address - Phone:480-747-3030
Practice Address - Fax:602-391-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00065974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist