Provider Demographics
NPI:1508642844
Name:BALDWIN, MALLORI LAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALLORI
Middle Name:LAYNE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HIGHWAY 153
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-7515
Mailing Address - Country:US
Mailing Address - Phone:864-295-2029
Mailing Address - Fax:
Practice Address - Street 1:3501 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7515
Practice Address - Country:US
Practice Address - Phone:864-295-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist