Healthcare Provider Details

I. General information

NPI: 1326222571
Provider Name (Legal Business Name): GARY KEITH BAUMANN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-37 HICKSVILLE RD
MASSAPEQUA NY
11758-5818
US

IV. Provider business mailing address

911 LINCOLN AVE
NORTH BALDWIN NY
11510-2806
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-7211
  • Fax:
Mailing address:
  • Phone: 516-223-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: