Provider Demographics
NPI:1184225641
Name:BALDWIN, MISTI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MISTI
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 EDENBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8296
Mailing Address - Country:US
Mailing Address - Phone:678-524-1187
Mailing Address - Fax:
Practice Address - Street 1:2205 HARRISON RD SE
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7455
Practice Address - Country:US
Practice Address - Phone:706-595-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist