MEDICARE: BLAKE W CHRISTIANSEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12420	CO

General Provider Information

NPI Number	:	1730017203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE W CHRISTIANSEN RPH

Provider Business Mailing Address
First Line	:	9249 W BALTIC DR
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-2280
Country	:	US
Telephone Number	:	303-359-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	9249 W BALTIC DR
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-2280
Country	:	US
Telephone Number	:	303-359-1351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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