Roosevelt Alonzo Blye Jr., PHARM.D
Individual provider Active NPI Pharmacist · Long Beach, MS
NPI 1780974238 · NPPES record last updated Apr 18, 2011
Key facts
- NPI
- 1780974238
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 09535 (MS)
- Practice address
- 200 West Railroad Street Suite B
Rite Aid
Long Beach, MS 39560-2269 - Phone
- (228) 864-0334
- NPI assigned
- Apr 18, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 09535 | MS | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 09535 | MS | Yes |
Addresses
Primary practice location
200 West Railroad Street Suite B
Rite Aid
Long Beach, MS 39560-2269
Mailing address
1593 Rachel Drive
Biloxi, MS 39532
Phone (228) 392-0112
Other providers in Long Beach, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2011. 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.