Provider Demographics
NPI:1962688648
Name:BAUBLITZ, KIMBERLY J (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:J
Last Name:BAUBLITZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3274
Mailing Address - Country:US
Mailing Address - Phone:315-769-1078
Mailing Address - Fax:315-705-0060
Practice Address - Street 1:49 SMITH RD
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3274
Practice Address - Country:US
Practice Address - Phone:315-769-1078
Practice Address - Fax:315-705-0060
Is Sole Proprietor?:No
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01413652Medicaid