Provider Demographics
NPI:1710380761
Name:BALDWIN RD PHARMACY INC
Entity Type:Organization
Organization Name:BALDWIN RD PHARMACY INC
Other - Org Name:LAPEER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-245-9600
Mailing Address - Street 1:944 BALDWIN RD
Mailing Address - Street 2:STE B
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3089
Mailing Address - Country:US
Mailing Address - Phone:810-245-9600
Mailing Address - Fax:810-969-4013
Practice Address - Street 1:944 BALDWIN RD STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3089
Practice Address - Country:US
Practice Address - Phone:810-245-9600
Practice Address - Fax:810-969-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
MI53010105893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710380761Medicaid
2148133OtherPK
7258150001Medicare NSC