MEDICARE: MRS. LISA B BAUMAN RPH, CPH

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	PS 30033	FL
2	183500000X	Pharmacist	PU 5561	FL

General Provider Information

NPI Number	:	1699842039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA B BAUMAN RPH, CPH

Provider Business Mailing Address
First Line	:	1105 DUSK VIEW DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-6069
Country	:	US
Telephone Number	:	321-452-6682
Fax Number	:	321-452-6716

Provider Business Practice Location Address
First Line	:	119 N BANANA RIVER DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2546
Country	:	US
Telephone Number	:	321-452-0010
Fax Number	:	321-452-6716

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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