Provider Demographics
NPI:1750977260
Name:BAILAS, AMY BAUMBACH (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BAUMBACH
Last Name:BAILAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:BAUMBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:38 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1927
Mailing Address - Country:US
Mailing Address - Phone:203-615-8678
Mailing Address - Fax:646-441-4683
Practice Address - Street 1:38 MARSH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612-1927
Practice Address - Country:US
Practice Address - Phone:203-615-8678
Practice Address - Fax:646-441-4683
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist