Provider Demographics
NPI:1548623341
Name:BLAU, DEREK
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BLAU
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:CHANDLER
Other - Last Name:BLAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8501 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3220
Mailing Address - Country:US
Mailing Address - Phone:913-894-2079
Mailing Address - Fax:913-888-8472
Practice Address - Street 1:8501 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3220
Practice Address - Country:US
Practice Address - Phone:913-894-2079
Practice Address - Fax:913-888-8472
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist