Derick Bledsoe

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

14317 Issued in NV

Practice address

2540 S Maryland Pkwy
Las Vegas, NV 89109-1627

Phone

(702) 791-0517

Fax

(702) 732-7899

NPI assigned

Jan 22, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1659901387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 S MARYLAND PKWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891091627",
            "telephone_number": "702-791-0517",
            "fax_number": "702-732-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 S MARYLAND PKWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891091627",
            "telephone_number": "702-791-0517",
            "fax_number": "702-732-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "DERICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NV",
            "license": "14317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Rose Blazer
• Blazing Fast Deliveries
• Carice Cathleen Blazo, LADC
• Todd Bleak, PHARM.D.
• Bryan Edward Bledsoe, D.O.
• Jessica Bledsoe, FNP-BC
• Laverne Rose Bledsoe
• Pamela Anne Bledsoe, APRN
• Nadine Bleeker, MS
• Stacy Bleser

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.