=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255612800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA BAUMANN PHARM.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2011
-----------------------------------------------------
Last Update Date | 09/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 CROSSROADS PL
-----------------------------------------------------
City | HIGH RIDGE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63049-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-376-4785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 MEADOW GROVE DR
-----------------------------------------------------
City | HOUSE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63051-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-604-4207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2007022481
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------