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General NPI Number Information
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NPI Number | 1801040720
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Entity Type | Organization
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Legal Business Name | BAUDER PHARMACY
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 3802 INGERSOLL AVE
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City | DES MOINES
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State | IA
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Zip | 50312-3413
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Country | US
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Telephone | 515-255-1124
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 INGERSOLL AVE
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City | DES MOINES
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State | IA
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Zip | 50312-3413
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Country | US
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Telephone | 515-255-1124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK GRAZIANO
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Credential | RPH
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Telephone | 515-255-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 222
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License Number State | IA
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