DERYCK BLAKE

LITHONIA, GA
NPI1568067114
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy183500000X Pharmacist
(Licence: GA  RPH016053)
Enumeration Date2020-12-02
Last Update Date2020-12-02
Business Address
DERYCK BLAKE RPH
5401 FAIRINGTON RD
LITHONIA, GA 30038-5113
Phone number: 770-593-4998
Mailing Address
DERYCK BLAKE RPH
882 HERITAGE PL
DECATUR, GA 30033-4104
Phone number: 678-776-4569