Provider Demographics
NPI:1427330422
Name:BAUM, JENNIFER SNELLGROVE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SNELLGROVE
Last Name:BAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BRITAIN CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7161
Mailing Address - Country:US
Mailing Address - Phone:337-412-6486
Mailing Address - Fax:
Practice Address - Street 1:100 S CUSHING AVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-5301
Practice Address - Country:US
Practice Address - Phone:337-643-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist