BEAU BLAKE
NPI 1417830811
Pharmacist in Madison, WI

Active since July 31, 2025
4602 EASTPARK BLVD, MADISON, WI 53718(608) 440-6400 Get Directions Write a Review

NPPES record last updated: July 31, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Beau Blake NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEAU BLAKE (NPI 1417830811) is an individual pharmacist in Madison, Wisconsin, licensed in Wisconsin (22042) and active in the NPI registry since July 2025.

NPPES Registry Identity

NPI1417830811
Entity TypeIndividualMale
Primary Taxonomy183500000X
Provider Legal NameBEAU BLAKE
Location Address4602 EASTPARK BLVDMadison, WI 53718-2002
Mailing Address1010 E Washington Ave Apt 1019Madison, WI 53703-4414 · (262) 995-5275
Sole ProprietorNo
Enumeration DateJuly 31, 2025
NPPES CertifiedJuly 31, 2025
NPI 1417830811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPharmacistPharmacy Service Providers
Taxonomy Code183500000X
License Licensed in WI · 22042
Definition
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, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.
4602 EASTPARK BLVD, Madison, WI 53718

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
4602 EASTPARK BLVD
MADISON, WI 53718
Physician Assistant
4602 EASTPARK BLVD
MADISON, WI 53718
Physical Therapist
4602 EASTPARK BLVD
MADISON, WI 53718
Physical Therapist
4602 EASTPARK BLVD
MADISON, WI 53718
Physical Therapist (Sports)
4602 EASTPARK BLVD
MADISON, WI 53718
Surgery
4602 EASTPARK BLVD
MADISON, WI 53718
Physical Therapist
4602 EASTPARK BLVD
MADISON, WI 53718
Massage Therapist
4602 EASTPARK BLVD
MADISON, WI 53718

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Beau Blake's NPI number?

The NPI number for Beau Blake is 1417830811. It was assigned to this individual provider in the NPPES registry on July 31, 2025.

Where is Beau Blake located?

Beau Blake practices at 4602 Eastpark Blvd, Madison, WI 53718. The listed phone number is (608) 440-6400.

What is Beau Blake's specialty?

The primary specialty registered for this NPI is Pharmacist with taxonomy code 183500000X.

When was this NPI record last updated?

The NPPES record for Beau Blake was last updated on July 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.