Individual
DERYCK BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
5401 FAIRINGTON RD, LITHONIA, GA 30038-5113
(770) 593-4998
Mailing address
882 HERITAGE PL, DECATUR, GA 30033-4104
(678) 776-4569
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH016053
GA
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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