Individual
DR. BLAKE MARK LORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
5339 OLD HIGHWAY 5, WOODSTOCK, GA 30188-2431
(770) 924-6411
Mailing address
625 KNIGHTS BRIDGE DR, CANTON, GA 30115-5215
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
025563
GA
Other
Enumeration date
10/01/2010
Last updated
07/24/2014
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