Individual
DR. NATHAN THOMAS BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
2500 E LAKE ST, MINNEAPOLIS, MN 55406-1909
(612) 721-1611
(612) 721-1611
Mailing address
2021 145TH AVE NE, HAM LAKE, MN 55304-6240
(612) 483-6781
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
118039-8
MN
Other
Enumeration date
07/01/2005
Last updated
04/04/2011
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