Provider Demographics
NPI:1174512289
Name:BLAKE, ELIZABETH W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:W
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PRESQUE ISLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7746
Mailing Address - Country:US
Mailing Address - Phone:803-808-7227
Mailing Address - Fax:
Practice Address - Street 1:715 SUMTER ST
Practice Address - Street 2:ROOM 314A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-6058
Practice Address - Fax:803-777-1943
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy