MEDICARE: ALICIA GABRIELLE BLAKE PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15913	AL
2	183500000X	Pharmacist	36281	TN

General Provider Information

NPI Number	:	1043537665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA GABRIELLE BLAKE PHARM.D.

Provider Business Mailing Address
First Line	:	2525 PERIMETER PLACE DR
Second Line	:	STE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3674
Country	:	US
Telephone Number	:	866-720-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 PERIMETER PLACE DR
Second Line	:	STE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37214-3674
Country	:	US
Telephone Number	:	866-720-7626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	11/07/2014

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