Individual
BLAKE SHROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9430 BLUE RIDGE BLVD, KANSAS CITY, MO 64138-3846
(816) 765-5279
Mailing address
5 E 29TH ST, KANSAS CITY, MO 64108-3208
(660) 621-3703
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2014031542
MO
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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