Healthcare Provider Details

I. General information

NPI: 1831529619
Provider Name (Legal Business Name): JUNIUS BAUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 KIRKWOOD HWY
WILMINGTON DE
19805-4917
US

IV. Provider business mailing address

825 WYNNEWOOD RD
PHILADELPHIA PA
19151-3452
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-2511
  • Fax: 302-633-5443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP439418
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: