Provider Demographics
NPI:1760072425
Name:BAUMANN, CARL GEORGE JR (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:GEORGE
Last Name:BAUMANN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JOHNSON AVE N
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1327
Mailing Address - Country:US
Mailing Address - Phone:218-435-6646
Mailing Address - Fax:218-435-6493
Practice Address - Street 1:115 JOHNSON AVE N
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1327
Practice Address - Country:US
Practice Address - Phone:218-435-6646
Practice Address - Fax:218-435-6493
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist