Healthcare Provider Details

I. General information

NPI: 1750127056
Provider Name (Legal Business Name): BLAKE SOWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BLANCA AVE
ALAMOSA CO
81101-2340
US

IV. Provider business mailing address

16482 STATE HIGHWAY 136
LA JARA CO
81140-9473
US

V. Phone/Fax

Practice location:
  • Phone: 719-587-1260
  • Fax:
Mailing address:
  • Phone: 195-804-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: