MEDICARE: DR. TODD BLEAK PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11505	NV
2	1835P2201X	Ambulatory Care Pharmacist	11505	NV

General Provider Information

NPI Number	:	1417309709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD BLEAK PHARM.D.

Provider Business Mailing Address
First Line	:	2777 PARADISE RD UNIT 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-9028
Country	:	US
Telephone Number	:	702-461-5421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 ALMOND TREE LN STE 306
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3233
Country	:	US
Telephone Number	:	702-657-3873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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Directions to “ DR. TODD BLEAK PHARM.D.” Practice Location

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