Active NPI
Blake Wassom, PHARMD
- Ambulatory Care Pharmacist
- San Antonio, TX
National Provider Identifier
1669247490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 67146
- Practice address
- 5282 Medical Dr Ste 250
San Antonio, TX 78229-6039 - Phone
- (972) 644-2100
- NPI assigned
- Nov 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 67146 | TX | Primary |
Addresses
Primary practice location
5282 Medical Dr Ste 250
San Antonio, TX 78229-6039
Mailing address
4502 Medical Dr
San Antonio, TX 78229-4402
Phone (210) 358-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67146 | TX | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700524800000",
"number": "1669247490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4502 MEDICAL DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782294402",
"telephone_number": "210-358-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5282 MEDICAL DR STE 250",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782296039",
"telephone_number": "972-644-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSOM",
"first_name": "BLAKE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-21",
"last_updated": "2023-11-21",
"certification_date": "2023-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "TX",
"license": "67146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.