Provider Demographics
NPI:1982900650
Name:LAMM, BLAKE JENNINGS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:JENNINGS
Last Name:LAMM
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 1:14460 NEW FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-570-9083
Mailing Address - Fax:
Practice Address - Street 1:14460 NEW FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 165
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-570-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist