Provider Demographics
NPI:1245694942
Name:BAXTER, MARIAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CAMPBELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-9992
Mailing Address - Country:US
Mailing Address - Phone:203-931-1190
Mailing Address - Fax:203-931-1710
Practice Address - Street 1:355 CAMPBELL AVENUE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-9992
Practice Address - Country:US
Practice Address - Phone:203-931-1190
Practice Address - Fax:203-931-1710
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist