Provider Demographics
NPI:1003459397
Name:BLAKESLEE, SAMUEL AARIN (RPH)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:AARIN
Last Name:BLAKESLEE
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 1:2935 DESMET DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3047
Mailing Address - Country:US
Mailing Address - Phone:307-399-9698
Mailing Address - Fax:
Practice Address - Street 1:300 SE WYOMING BLVD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4201
Practice Address - Country:US
Practice Address - Phone:307-577-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist