Provider Demographics
NPI:1154643187
Name:BAE, JAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W STREET RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3100
Mailing Address - Country:US
Mailing Address - Phone:215-442-1300
Mailing Address - Fax:215-442-1301
Practice Address - Street 1:1535 W STREET RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3100
Practice Address - Country:US
Practice Address - Phone:215-442-1300
Practice Address - Fax:215-442-1301
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist