Kevin Martin Baumgartner, PHARMD
Individual provider Active NPI Pharmacist · Fort Wayne, IN
NPI 1497470728 · NPPES record last updated Oct 10, 2022
Key facts
- NPI
- 1497470728
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26030020A (IN)
- Practice address
- 11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701 - Phone
- (419) 806-7631
- NPI assigned
- Oct 10, 2022
- 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 |
|---|---|---|---|
| 26030020A | IN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26030020A | IN | Yes |
Addresses
Primary practice location
11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Mailing address
4905 Iris Ave Apt 626
Fort Wayne, IN 46825-2791
Phone (419) 806-7631
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2022. 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.