Provider Demographics
NPI:1457655268
Name:BAUMGARDNER, THAD D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THAD
Middle Name:D
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7332 LAKE FRONT DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6539
Mailing Address - Country:US
Mailing Address - Phone:814-659-3994
Mailing Address - Fax:704-504-3496
Practice Address - Street 1:14125 STEELE CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3968
Practice Address - Country:US
Practice Address - Phone:704-504-8199
Practice Address - Fax:704-504-8199
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17815183500000X
PARP440837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist