Provider Demographics
NPI:1831449925
Name:BLEISATH, ROY ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:ALLEN
Last Name:BLEISATH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S 23RD ST
Mailing Address - Street 2:P.O. BOX 397
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2180
Mailing Address - Country:US
Mailing Address - Phone:740-432-3810
Mailing Address - Fax:740-432-6803
Practice Address - Street 1:55 S 23RD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2180
Practice Address - Country:US
Practice Address - Phone:740-432-3810
Practice Address - Fax:740-432-6803
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03108219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist