Provider Demographics
NPI:1497741144
Name:BLAKE, CONRAD JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:JAMES
Last Name:BLAKE
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 1:2801 GROSMONT DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7047
Mailing Address - Country:US
Mailing Address - Phone:775-851-7788
Mailing Address - Fax:775-851-7787
Practice Address - Street 1:3515 AIRWAY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1849
Practice Address - Country:US
Practice Address - Phone:775-851-7788
Practice Address - Fax:775-851-7788
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV160761835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV16076OtherNV BOARD OF PHARMACY LIC