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General NPI Number Information
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NPI Number | 1184162364
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Entity Type | Individual
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Provider Name | BLAKELY A MILAM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 21720 CATAWBA AVE
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City | CORNELIUS
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State | NC
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Zip | 28031-0150
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Country | US
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Telephone | 704-895-5773
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Fax | 704-896-7724
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Provider Business Mailing Address
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Address Line | 303 E WATERLYNN RD
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City | MOORESVILLE
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State | NC
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Zip | 28115-8027
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Country | US
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Telephone | 910-431-6980
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Fax | 704-896-7724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24167
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License Number State | NC
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