Individual provider · Type 1 NPI

Beau Blake

Pharmacist · Madison, WI

NPI number 1417830811 Active

Practice location

4602 Eastpark Blvd
Madison, WI 53718-2002

Call (608) 440-6400 Map

Mailing address

1010 E Washington Ave Apt 1019
Madison, WI 53703-4414

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000X22042 (WI)

Pharmacist: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage…

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About NPI 1417830811

Beau Blake's National Provider Identifier is 1417830811, issued on Jul 31, 2025. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in Madison, WI. The record was last updated on Jul 31, 2025.