Provider Demographics
NPI:1093293607
Name:BAUS, ALLYSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:BAUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:3116 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1342
Mailing Address - Country:US
Mailing Address - Phone:404-273-4905
Mailing Address - Fax:
Practice Address - Street 1:3116 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1342
Practice Address - Country:US
Practice Address - Phone:404-273-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist