Provider Demographics
NPI:1184469199
Name:STICKLEY, BLAKE (RPH)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:STICKLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 BLOWING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6154
Mailing Address - Country:US
Mailing Address - Phone:828-268-0727
Mailing Address - Fax:
Practice Address - Street 1:2184 BLOWING ROCK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6154
Practice Address - Country:US
Practice Address - Phone:828-268-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist