Healthcare Provider Details

I. General information

NPI: 1346650082
Provider Name (Legal Business Name): NOLAN JAMES BAUER PHARM-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 HIGHWAY 95 N
LAKE HAVASU CITY AZ
86404-9646
US

IV. Provider business mailing address

5695 HIGHWAY 95 N
LAKE HAVASU CITY AZ
86404-9646
US

V. Phone/Fax

Practice location:
  • Phone: 928-764-3737
  • Fax:
Mailing address:
  • Phone: 928-764-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019610
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: