Provider Demographics
NPI:1043537665
Name:BLAKE, ALICIA GABRIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GABRIELLE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:GABRIELLE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2525 PERIMETER PLACE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3674
Mailing Address - Country:US
Mailing Address - Phone:866-720-7626
Mailing Address - Fax:
Practice Address - Street 1:2525 PERIMETER PLACE DR
Practice Address - Street 2:STE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3674
Practice Address - Country:US
Practice Address - Phone:866-720-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15913183500000X
TN36281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist