Healthcare Provider Details

I. General information

NPI: 1114543667
Provider Name (Legal Business Name): BLAKE EVANS GROGAN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 ARAPAHOE RD
LAFAYETTE CO
80026-8054
US

IV. Provider business mailing address

2900 ARAPAHOE RD
LAFAYETTE CO
80026-8054
US

V. Phone/Fax

Practice location:
  • Phone: 303-301-1170
  • Fax:
Mailing address:
  • Phone: 303-301-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5351016688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: