Provider Demographics
NPI:1124656509
Name:BAUM, DUSTIN LUCAS (PHARMD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LUCAS
Last Name:BAUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17796 HANNAN TRACE RD
Mailing Address - Street 2:
Mailing Address - City:CROWN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45623-9015
Mailing Address - Country:US
Mailing Address - Phone:330-447-2119
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL CENTER DR STE B500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3655
Practice Address - Country:US
Practice Address - Phone:304-691-1779
Practice Address - Fax:304-691-1882
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00105291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist