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NPI Code Detail

MEDICARE: BLAKE SHROUT

MEDICARE: BLAKE SHROUT
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
1183500000XPharmacist2014031542MO

General Provider Information

NPI Number : 1730582552
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE SHROUT
Provider Business Mailing Address
First Line : 5 E 29TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-3208
Country : US
Telephone Number : 660-621-3703
Fax Number :
Provider Business Practice Location Address
First Line : 9430 BLUE RIDGE BLVD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64138-3846
Country : US
Telephone Number : 816-765-5279
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2014
Last Update Date : 10/07/2014

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Directions to “ BLAKE SHROUT ” Practice Location

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