Provider Demographics
NPI:1528660008
Name:BAIR, MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BAIR
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 1:146 W 200 S
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9099
Mailing Address - Country:US
Mailing Address - Phone:435-783-1316
Mailing Address - Fax:435-783-4370
Practice Address - Street 1:146 W 200 S
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-9099
Practice Address - Country:US
Practice Address - Phone:435-783-1316
Practice Address - Fax:435-783-4370
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9523279-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist