Provider Demographics
NPI:1699842039
Name:BAUMAN, LISA B (RPH, CPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 DUSK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-6069
Mailing Address - Country:US
Mailing Address - Phone:321-452-6682
Mailing Address - Fax:321-452-6716
Practice Address - Street 1:119 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2546
Practice Address - Country:US
Practice Address - Phone:321-452-0010
Practice Address - Fax:321-452-6716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 30033183500000X
FLPU 5561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist