NPIMap

Organization Active NPI

Bauder Pharmacy

  • Home Infusion Therapy Pharmacy
  • Des Moines, IA
National Provider Identifier
1801040720
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
License
222 Issued in IA
Legal business name
BAUDER PHARMACY
Practice address
3802 Ingersoll Ave
Des Moines, IA 50312-3413
Phone
(515) 255-1124
NPI assigned
Nov 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Graziano, RPH
Title
Owner
Phone
(515) 255-1124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Therapy Pharmacy 3336H0001X 222 IA Primary

Addresses

Primary practice location

3802 Ingersoll Ave
Des Moines, IA 50312-3413

Mailing address

3802 Ingersoll Ave
Des Moines, IA 50312-3413
Phone (515) 255-1124

Other identifiers 1

IdentifierTypeStateIssuer
0037291MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Bauder Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3802 Ingersoll Ave
Des Moines, IA 50312
Phone (515) 255-1124

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1801040720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 INGERSOLL AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123413",
            "telephone_number": "515-255-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 INGERSOLL AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123413",
            "telephone_number": "515-255-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAUDER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "GRAZIANO",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-255-1124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "IA",
            "license": "222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0037291",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.