Provider Demographics
NPI:1326390808
Name:HENSLEY, BLAKE CECIL (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:CECIL
Last Name:HENSLEY
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 1:595 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5859
Mailing Address - Country:US
Mailing Address - Phone:765-749-0675
Mailing Address - Fax:
Practice Address - Street 1:873 W CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5804
Practice Address - Country:US
Practice Address - Phone:317-580-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024586A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist