Provider Demographics
NPI:1760750442
Name:BAUER, GLORIA A (RP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:BAUER
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S 173RD CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-3106
Mailing Address - Country:US
Mailing Address - Phone:402-697-9393
Mailing Address - Fax:402-697-0487
Practice Address - Street 1:903 S 173RD CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3106
Practice Address - Country:US
Practice Address - Phone:402-697-9393
Practice Address - Fax:402-697-0487
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist