MEDICARE: DANIELLE BAE

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	5302413334	MI

General Provider Information

NPI Number	:	1528636925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE BAE

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-0023
Country	:	US
Telephone Number	:	224-806-6924
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 N EDDY ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-3096
Country	:	US
Telephone Number	:	574-246-8816
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	04/08/2026

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