Healthcare Provider Details

I. General information

NPI: 1093303364
Provider Name (Legal Business Name): BLAKE MICHAEL VACZI PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 BENEVA RD
SARASOTA FL
34232-3152
US

IV. Provider business mailing address

1231 BENEVA RD
SARASOTA FL
34232-3152
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-4353
  • Fax:
Mailing address:
  • Phone: 941-365-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: