Provider Demographics
NPI:1598045114
Name:BAULA, VICTOR (PHARM D)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BAULA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 W FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4219
Mailing Address - Country:US
Mailing Address - Phone:702-871-1905
Mailing Address - Fax:702-871-2604
Practice Address - Street 1:7845 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4219
Practice Address - Country:US
Practice Address - Phone:702-871-1905
Practice Address - Fax:702-871-2604
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist