Provider Demographics
NPI:1396349486
Name:BAUMGARDNER, TIMOTHY HANSON (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HANSON
Last Name:BAUMGARDNER
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 1:9167 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2027
Mailing Address - Country:US
Mailing Address - Phone:804-672-6613
Mailing Address - Fax:804-672-0195
Practice Address - Street 1:9167 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2027
Practice Address - Country:US
Practice Address - Phone:804-672-6613
Practice Address - Fax:804-672-0195
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist