| Doctor Name: | MR. ALVIN BLACKMON |
| NPI Number: | 1104125095 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD |
| License Number: | 017025 |
| Business Practice Address: | 300 W Hospital Rd Fort Gordon, GA - 309055741 |
| Business Phone Number: | 7067877763 |
| Business Fax Number: | |
| Mailing Address: | 300 W Hospital Rd, FORT GORDON |
| State: | GA |
| Postal Code: | 309055741 |
| Phone Number: | 7067877763 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2011 |
| NPI Last Update Date: | 03/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N0905X |
| License Number: | 017025 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nuclear |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in procurement, compounding, quality control testing, dispensing, distribution, and monitoring of radiopharmaceuticals. |