Provider Demographics
NPI:1417309709
Name:BLEAK, TODD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:BLEAK
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 1:2777 PARADISE RD UNIT 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-9028
Mailing Address - Country:US
Mailing Address - Phone:702-461-5421
Mailing Address - Fax:
Practice Address - Street 1:1140 ALMOND TREE LN STE 306
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3233
Practice Address - Country:US
Practice Address - Phone:702-657-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11505183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist