Provider Demographics
NPI:1336799030
Name:BAIDEN, JOJO
Entity Type:Individual
Prefix:
First Name:JOJO
Middle Name:
Last Name:BAIDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GLENDALE AVE APT 124
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3739
Mailing Address - Country:US
Mailing Address - Phone:302-887-6119
Mailing Address - Fax:
Practice Address - Street 1:1201 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5804
Practice Address - Country:US
Practice Address - Phone:215-646-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist