Provider Demographics
NPI:1164739223
Name:BAUER, GARRY DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:DAVID
Last Name:BAUER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 MORGAN BLVD
Mailing Address - Street 2:HEB #168
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-440-1984
Mailing Address - Fax:956-440-1990
Practice Address - Street 1:1103 MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5152
Practice Address - Country:US
Practice Address - Phone:956-440-1984
Practice Address - Fax:956-440-1990
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist