Provider Demographics
NPI:1760023105
Name:BAHM, JOEL NEILSON
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:NEILSON
Last Name:BAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 SHEFFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2799
Mailing Address - Country:US
Mailing Address - Phone:866-444-6290
Mailing Address - Fax:877-486-4545
Practice Address - Street 1:2003 SHEFFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2758
Practice Address - Country:US
Practice Address - Phone:866-444-6290
Practice Address - Fax:877-486-4545
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031072L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007458630052Medicaid