Carl George Baumann Jr., RPH
Individual provider Active NPI Pharmacist · Fosston, MN
NPI 1760072425 · NPPES record last updated Jan 26, 2021
Key facts
- NPI
- 1760072425
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 115410 (MN)
- Practice address
- 115 Johnson Ave N
Fosston, MN 56542-1327 - Phone
- (218) 435-6646
- Fax
- (218) 435-6493
- NPI assigned
- Jan 26, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115410 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fosston Pharmacy & Gifts Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 115410 | MN | Yes |
Addresses
Primary practice location
115 Johnson Ave N
Fosston, MN 56542-1327
Mailing address
115 Johnson Ave N
Fosston, MN 56542-1327
Phone (218) 435-6646
Other providers in Fosston, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2021. 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.