Provider Demographics
NPI:1598241523
Name:SCHADE, BLAKE ALLAN
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ALLAN
Last Name:SCHADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 WENTZVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3453
Mailing Address - Country:US
Mailing Address - Phone:636-332-9948
Mailing Address - Fax:636-332-0811
Practice Address - Street 1:1960 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3453
Practice Address - Country:US
Practice Address - Phone:636-332-9948
Practice Address - Fax:636-332-0811
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist