Provider Demographics
NPI:1922673482
Name:GREATER BADEN MEDICAL SERVICE, INC.
Entity Type:Organization
Organization Name:GREATER BADEN MEDICAL SERVICE, INC.
Other - Org Name:GREATER BADEN MEDICAL SERVICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:DR
Authorized Official - First Name:WYNDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA, PHD
Authorized Official - Phone:301-599-2172
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:7450 ALBERT ROAD
Practice Address - Street 2:SUITE 131
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613
Practice Address - Country:US
Practice Address - Phone:240-207-2970
Practice Address - Fax:240-213-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy