Healthcare Provider Details

I. General information

NPI: 1497741144
Provider Name (Legal Business Name): CONRAD JAMES BLAKE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 AIRWAY DR SUITE 210
RENO NV
89511-1849
US

IV. Provider business mailing address

2801 GROSMONT DR
SPARKS NV
89436-7047
US

V. Phone/Fax

Practice location:
  • Phone: 775-851-7788
  • Fax: 775-851-7788
Mailing address:
  • Phone: 775-851-7788
  • Fax: 775-851-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberNV16076
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: