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General NPI Number Information
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NPI Number | 1346858107
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Entity Type | Individual
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Provider Name | BAOTRAM VAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 1481 W 10TH ST # 119
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2803
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Country | US
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Telephone | 317-988-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 232 E VINELAND RD
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City | AUGUSTA
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State | GA
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Zip | 30904-3414
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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