Provider Demographics
NPI:1346901949
Name:BALDWIN, RANDY GLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:GLEN
Last Name:BALDWIN
Suffix:
Gender:M
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:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-0711
Mailing Address - Country:US
Mailing Address - Phone:402-723-4475
Mailing Address - Fax:402-723-4476
Practice Address - Street 1:1060 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-9798
Practice Address - Country:US
Practice Address - Phone:402-723-4475
Practice Address - Fax:402-723-4476
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist