Healthcare Provider Details

I. General information

NPI: 1972684819
Provider Name (Legal Business Name): STEPHEN LLEWELLYN BLAKESLEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN LLEWELLYN BLAKESLEE RPH

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

371 S DIVISION ST
HORNELL NY
14843-2135
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4000
  • Fax:
Mailing address:
  • Phone: 607-324-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026567-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: