Provider Demographics
NPI:1164704342
Name:BLAKELY, BENJAMIN JOSEPH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VICK PARK A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2120
Mailing Address - Country:US
Mailing Address - Phone:585-880-0361
Mailing Address - Fax:
Practice Address - Street 1:565 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3117
Practice Address - Country:US
Practice Address - Phone:585-244-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist