Healthcare Provider Details

I. General information

NPI: 1043207491
Provider Name (Legal Business Name): BLAKE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N MAIN ST
PEEBLES OH
45660-1246
US

IV. Provider business mailing address

103 N MAIN ST
PEEBLES OH
45660-1246
US

V. Phone/Fax

Practice location:
  • Phone: 937-587-3100
  • Fax: 937-587-5045
Mailing address:
  • Phone: 937-587-3100
  • Fax: 937-587-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT PAUL APPLEGATE
Title or Position: PHARMACIST/MGR.
Credential: RPH
Phone: 937-587-3100