Provider Demographics
NPI:1215078282
Name:REMBLAKE, THERESE I (BS PHARM)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:I
Last Name:REMBLAKE
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23425 N 39TH DR
Mailing Address - Street 2:25239 N 40TH LANE
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-4199
Mailing Address - Country:US
Mailing Address - Phone:623-869-6507
Mailing Address - Fax:623-869-6609
Practice Address - Street 1:23425 N 39TH DR
Practice Address - Street 2:25239 N 40TH LN
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4199
Practice Address - Country:US
Practice Address - Phone:623-869-6507
Practice Address - Fax:623-869-6609
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist