Provider Demographics
NPI:1023608361
Name:BAUMGARTNER, MAREN HAZEN
Entity type:Individual
Prefix:DR
First Name:MAREN
Middle Name:HAZEN
Last Name:BAUMGARTNER
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 1:1028 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5181
Mailing Address - Country:US
Mailing Address - Phone:801-479-0331
Mailing Address - Fax:
Practice Address - Street 1:1028 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5181
Practice Address - Country:US
Practice Address - Phone:801-479-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774266-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2774266-1701OtherPHARMACY LICENSE