Provider Demographics
NPI:1801172416
Name:BLAKE, DAWN ELAINE (RPH)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ELAINE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 FLAG CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4919
Mailing Address - Country:US
Mailing Address - Phone:205-789-6785
Mailing Address - Fax:
Practice Address - Street 1:9301 HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5366
Practice Address - Country:US
Practice Address - Phone:205-664-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN262183500000X
AR6258183500000X
AL13579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist