# BLAKE PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blake Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811000144
- **Authorized official:** DUSTIN CAMPBELL (PHARMACIST/MGR)
- **Authorized official phone:** (937) 587-3100

## Contact information

- **Practice address:** 103 N MAIN ST, PEEBLES, OH 45660-1246
- **Practice address phone:** (937) 587-3100
- **Practice address fax:** (937) 587-5045
- **Mailing address:** 103 N MAIN ST, PEEBLES, OH 45660-1246
- **Mailing address phone:** (937) 587-3100
- **Mailing address fax:** (937) 587-5045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 022368600 | OH | Yes |

## Other

- **Enumeration date:** 08/17/2006
- **Last updated:** 02/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0315297 | — | OH |
| 01 | — | 2143874 | PK | — |