Provider Demographics
NPI:1598017477
Name:RETZLAFF, BLYTHE ASHLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:ASHLEY
Last Name:RETZLAFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:ASHLEY
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 FOSTER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3198
Mailing Address - Country:US
Mailing Address - Phone:419-410-4051
Mailing Address - Fax:
Practice Address - Street 1:1627 HENTHORNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1370
Practice Address - Country:US
Practice Address - Phone:419-865-0337
Practice Address - Fax:419-865-0629
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132100183500000X
TN37063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist