Provider Demographics
NPI:1659576585
Name:BAUMAN, GARY R (BSPHARM, RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:BSPHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1860
Mailing Address - Country:US
Mailing Address - Phone:330-665-2317
Mailing Address - Fax:330-665-2274
Practice Address - Street 1:1761 N CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-1860
Practice Address - Country:US
Practice Address - Phone:330-665-2317
Practice Address - Fax:330-665-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-12893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist