| Organization Name: | BLACKLOG APOTHECARY INC |
| NPI Number: | 1831235480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDALL CHAFFIN (OWNER PHARMACIST) |
| Mailing Address: | Route 40 East Inez |
| State: | KY US |
| Postal Code: | 41224 |
| Phone Number: | 6062987774 |
| Fax Number: | 6062987564 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 03/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | P01894 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |