Provider Demographics
NPI:1184162364
Name:MILAM, BLAKELY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BLAKELY
Middle Name:A
Last Name:MILAM
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 1:303 E WATERLYNN RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8027
Mailing Address - Country:US
Mailing Address - Phone:910-431-6980
Mailing Address - Fax:704-896-7724
Practice Address - Street 1:21720 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-0150
Practice Address - Country:US
Practice Address - Phone:704-895-5773
Practice Address - Fax:704-896-7724
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist