Provider Demographics
NPI:1720332687
Name:FRANCISCO, BLAKE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 W HARVESTMILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-1794
Mailing Address - Country:US
Mailing Address - Phone:503-858-0046
Mailing Address - Fax:
Practice Address - Street 1:7859 S 3200 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5230
Practice Address - Country:US
Practice Address - Phone:801-255-7557
Practice Address - Fax:801-266-4876
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013242183500000X
UT7684410-8911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist