Healthcare Provider Details

I. General information

NPI: 1821547233
Provider Name (Legal Business Name): CASEY BAUMGARTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/26/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E MOUNTAIN BLVD
WILKES BARRE PA
18702
US

IV. Provider business mailing address

559 PERRY RD
WYOMING PA
18644-6015
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-6113
  • Fax:
Mailing address:
  • Phone: 570-905-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP451094
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451094
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: