MEDICARE: GEORGE BAUER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PCT.0009217	CT

General Provider Information

NPI Number	:	1093092769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE BAUER

Provider Business Mailing Address
First Line	:	4 COPPER RIDGE RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-4278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 BUCKLAND HILLS DR
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-8701
Country	:	US
Telephone Number	:	860-327-0083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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