Provider Demographics
NPI:1720359003
Name:BAUER, RBOIN TIMOTHY (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:RBOIN
Middle Name:TIMOTHY
Last Name:BAUER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25025 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-8577
Mailing Address - Country:US
Mailing Address - Phone:601-774-2772
Mailing Address - Fax:601-774-8779
Practice Address - Street 1:25025 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365-8577
Practice Address - Country:US
Practice Address - Phone:601-774-2772
Practice Address - Fax:601-774-8779
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist