MEDICARE: DR. THAD D. BAUMGARDNER PHARMD

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	17815	NC
2	183500000X	Pharmacist	RP440837	PA

General Provider Information

NPI Number	:	1457655268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THAD D. BAUMGARDNER PHARMD

Provider Business Mailing Address
First Line	:	7332 LAKE FRONT DR UNIT 5
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6539
Country	:	US
Telephone Number	:	814-659-3994
Fax Number	:	704-504-3496

Provider Business Practice Location Address
First Line	:	14125 STEELE CREEK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-3968
Country	:	US
Telephone Number	:	704-504-8199
Fax Number	:	704-504-8199

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

Provider Enumeration Date	:	01/08/2011
Last Update Date	:	01/08/2011

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