Provider Demographics
NPI:1760086250
Name:BAUER, JOHN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:BAUER
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 1:68 WOOD DUCK LN
Mailing Address - Street 2:
Mailing Address - City:ZION CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22942-6531
Mailing Address - Country:US
Mailing Address - Phone:727-366-3792
Mailing Address - Fax:
Practice Address - Street 1:1417 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2606
Practice Address - Country:US
Practice Address - Phone:434-244-4028
Practice Address - Fax:434-244-7908
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202212928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist