Provider Demographics
NPI:1255754420
Name:O'NEILL, BLAKE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:O'NEILL
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 1:425 S SUNRISE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7664
Mailing Address - Country:US
Mailing Address - Phone:760-327-4381
Mailing Address - Fax:760-327-4388
Practice Address - Street 1:425 S SUNRISE WAY STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7664
Practice Address - Country:US
Practice Address - Phone:760-327-4381
Practice Address - Fax:760-327-4388
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65338183500000X
NC21402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist