Provider Demographics
NPI:1851528632
Name:BAUMAN, PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BAUMAN
Suffix:
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 1:2 RIVERSIDE PLZ
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-1137
Mailing Address - Country:US
Mailing Address - Phone:570-638-2820
Mailing Address - Fax:
Practice Address - Street 1:2 RIVERSIDE PLZ
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-1137
Practice Address - Country:US
Practice Address - Phone:570-638-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33197-1183500000X
PARP033981R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist