Provider Demographics
NPI:1508171273
Name:BAKKEN, GLADYS BAUZON (RPH, CIP)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:BAUZON
Last Name:BAKKEN
Suffix:
Gender:F
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17340-9239
Mailing Address - Country:US
Mailing Address - Phone:717-337-1467
Mailing Address - Fax:
Practice Address - Street 1:1430 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8529
Practice Address - Country:US
Practice Address - Phone:717-632-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441652183500000X
MD18126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist