Conrad James Blake – Pharmacotherapy Pharmacist

Key facts

NPI: 1497741144
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacotherapy Pharmacist 1835P1200X
License: NV16076 (NV)
Practice address: 3515 Airway Dr
Suite 210
Reno, NV 89511-1849
Phone: (775) 851-7788
Fax: (775) 851-7788
NPI assigned: Sep 27, 2005
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Pax RX LLC Community/Retail Pharmacy · Reno, NV · NPI 1487690863

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Pharmacy

State licenses

License	State	Type	Specialty
NV16076	NV	MD	Pharmacotherapy Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Pax RX LLC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacotherapy Pharmacist	1835P1200X	NV16076	NV	Yes

Addresses

Primary practice location

3515 Airway Dr
Suite 210
Reno, NV 89511-1849

Mailing address

2801 Grosmont Dr
Sparks, NV 89436-7047
Phone (775) 851-7788

Other identifiers

Identifier	Type	State	Issuer
NV16076	Other	NV	NV BOARD OF PHARMACY LIC

Other providers in Reno, NV

All providers in Reno, NV · Pharmacotherapy Pharmacist in Nevada

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.