Provider Demographics
NPI:1225314073
Name:BAUER, MEGHAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CONNECTICUT BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3007
Mailing Address - Country:US
Mailing Address - Phone:860-289-4944
Mailing Address - Fax:860-289-3817
Practice Address - Street 1:20 CONNECTICUT BLVD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3007
Practice Address - Country:US
Practice Address - Phone:860-289-4944
Practice Address - Fax:860-289-3817
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0009101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist