Deryck Blake, RPH Valid NPI
Individual provider · Pharmacist · Lithonia, GA
- NPI
- 1568067114
- Type
- Individual (Type 1)
- Primary specialty
- Pharmacist
- Specialty group
- Pharmacy Service Providers
- Taxonomy code
- 183500000X
- License number
- RPH016053 (GA)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2020-12-02
- Last updated
- 2020-12-02
Practice location
5401 Fairington Rd
Lithonia, GA 30038-5113
(770) 593-4998