Provider Demographics
NPI:1508400623
Name:BAUR, ALBERT EDWIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:EDWIN
Last Name:BAUR
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 NE 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-7457
Mailing Address - Country:US
Mailing Address - Phone:863-697-1477
Mailing Address - Fax:
Practice Address - Street 1:1005 W SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-2706
Practice Address - Country:US
Practice Address - Phone:863-983-8756
Practice Address - Fax:863-983-6398
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist