Provider Demographics
NPI:1801374632
Name:BAUMAN, BRITTANY KAY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KAY
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W DEER VALLEY RD STE 103-106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2138
Mailing Address - Country:US
Mailing Address - Phone:602-616-3787
Mailing Address - Fax:
Practice Address - Street 1:20427 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3241
Practice Address - Country:US
Practice Address - Phone:623-869-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist