Provider Demographics
NPI:1316536642
Name:BAUER, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2126
Mailing Address - Country:US
Mailing Address - Phone:361-275-8934
Mailing Address - Fax:361-275-4493
Practice Address - Street 1:909 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2126
Practice Address - Country:US
Practice Address - Phone:361-275-8934
Practice Address - Fax:361-275-4493
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician