Provider Demographics
NPI:1245563113
Name:BALDWIN, ROBERT L (CPHT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 RUMSEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3933
Mailing Address - Country:US
Mailing Address - Phone:206-333-0634
Mailing Address - Fax:206-333-0634
Practice Address - Street 1:1028 RUMSEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3933
Practice Address - Country:US
Practice Address - Phone:206-333-0634
Practice Address - Fax:206-333-0634
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH290101040752345183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician