Blair Adam Baillio, PHARMD
Individual provider Active NPI Pharmacist · Beaver Dam, WI
NPI 1215548516 · NPPES record last updated Aug 11, 2020
Key facts
- NPI
- 1215548516
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 20452-40 (WI)
- Practice address
- 609 N Spring St
Beaver Dam, WI 53916-2040 - Phone
- (920) 356-1500
- NPI assigned
- Aug 11, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20452-40 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20452-40 | WI | Yes |
Addresses
Primary practice location
609 N Spring St
Beaver Dam, WI 53916-2040
Mailing address
609 N Spring St
Beaver Dam, WI 53916-2040
Phone (920) 356-1500
Other providers in Beaver Dam, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.