Provider Demographics
NPI:1043973126
Name:BLAKELEY, RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SEVASTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12692 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2596
Mailing Address - Country:US
Mailing Address - Phone:440-729-5457
Mailing Address - Fax:
Practice Address - Street 1:12692 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2596
Practice Address - Country:US
Practice Address - Phone:440-729-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist