Provider Demographics
NPI:1780227470
Name:BAUER, DEBORAH (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1632
Mailing Address - Country:US
Mailing Address - Phone:406-293-6821
Mailing Address - Fax:
Practice Address - Street 1:703 W 9TH ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1632
Practice Address - Country:US
Practice Address - Phone:406-293-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT004877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist