Provider Demographics
NPI:1457182875
Name:BALDWIN, MARY M (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
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 1:2205 N FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1009
Mailing Address - Country:US
Mailing Address - Phone:513-850-1246
Mailing Address - Fax:
Practice Address - Street 1:731 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3003
Practice Address - Country:US
Practice Address - Phone:937-573-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist