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General NPI Number Information
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NPI Number | 1578239554
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Entity Type | Individual
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Provider Name | BLAKE TROLLER RPH, PHARMD, BCPS
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Gender | Male
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1111 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-3323
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Country | US
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Telephone | 419-341-6764
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Fax |
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Provider Business Mailing Address
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Address Line | 509 PARKSIDE DR
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City | BAY VILLAGE
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State | OH
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Zip | 44140-2552
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Country | US
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Telephone | 419-341-6764
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Fax |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 03135538
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License Number State | OH
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