Provider Demographics
NPI:1316046097
Name:BAUER, KRISTIN MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12245 URBANK ST NE UNIT D
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5692
Mailing Address - Country:US
Mailing Address - Phone:763-420-3005
Mailing Address - Fax:763-420-8624
Practice Address - Street 1:12880 ELM CREEK BLVD N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7052
Practice Address - Country:US
Practice Address - Phone:763-420-3005
Practice Address - Fax:763-420-8624
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist