Healthcare Provider Details

I. General information

NPI: 1063828010
Provider Name (Legal Business Name): EMILY BLEW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY BERGKAMP PHARMD

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 W CENTRAL AVE
WICHITA KS
67212-2455
US

IV. Provider business mailing address

143 N RUTAN ST APT 349
WICHITA KS
67208-3359
US

V. Phone/Fax

Practice location:
  • Phone: 316-252-8600
  • Fax:
Mailing address:
  • Phone: 620-960-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115799
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number115799
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: