Provider Demographics
NPI:1366712325
Name:BAUGHMAN, DEANNA LEA (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LEA
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3914
Mailing Address - Country:US
Mailing Address - Phone:920-759-9165
Mailing Address - Fax:
Practice Address - Street 1:2412 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3914
Practice Address - Country:US
Practice Address - Phone:920-759-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15566-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist