Individual
PHILLIP BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
4301 WILSON ST, FORT SILL, OK 73503-4472
(580) 558-2300
Mailing address
1451 BARNETT RD, WICHITA FALLS, TX 76310-5213
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42642
TX
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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