Healthcare Provider Details

I. General information

NPI: 1942201371
Provider Name (Legal Business Name): PHIL GARY BAUMAL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 W MCNAB RD
TAMARAC FL
33321-3214
US

IV. Provider business mailing address

9518 BOCA RIVER CIR
BOCA RATON FL
33434-3961
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-6008
  • Fax:
Mailing address:
  • Phone: 561-756-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS29159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: