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General NPI Number Information
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NPI Number | 1245325844
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Entity Type | Organization
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Legal Business Name | BLAKE PHARMACY , INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 35 E SECOND ST
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City | MANCHESTER
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State | OH
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Zip | 45144-1301
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Country | US
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Telephone | 937-549-3773
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Fax | 937-549-3714
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Provider Business Mailing Address
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Address Line | 35 E SECOND ST
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City | MANCHESTER
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State | OH
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Zip | 45144-1301
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Country | US
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Telephone | 937-549-3773
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Fax | 937-549-3714
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KATHLEEN D HILL
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Credential | R.PH.
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Telephone | 937-549-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02-0481050
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License Number State | OH
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