Provider Demographics
NPI:1558362798
Name:BALDWIN, JASON O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:O
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 1:4002 CLEAR SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-0655
Mailing Address - Country:US
Mailing Address - Phone:352-540-6150
Mailing Address - Fax:813-783-6164
Practice Address - Street 1:4002 CLEAR SPRING RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-0655
Practice Address - Country:US
Practice Address - Phone:352-540-6150
Practice Address - Fax:813-783-6164
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33359183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy