Provider Demographics
NPI:1245515329
Name:BALDWIN, DIANE LOUISE (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4258
Mailing Address - Country:US
Mailing Address - Phone:573-874-3562
Mailing Address - Fax:573-874-2891
Practice Address - Street 1:222 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4258
Practice Address - Country:US
Practice Address - Phone:573-874-3562
Practice Address - Fax:573-874-2891
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044960183500000X
MI5302023040183500000X
IN26013926A183500000X
IA19946183500000X
KY015300183500000X
IL051.290910183500000X
KS1-15151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist