Individual
ANN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4764 SALINA ST, PULASKI, NY 13142-4715
(315) 298-6027
Mailing address
4764 SALINA ST, PULASKI, NY 13142-4715
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
048294
NY
Other
Enumeration date
12/09/2007
Last updated
04/29/2011
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