Provider Demographics
NPI:1720788318
Name:BALDWIN PHARMACY LLC
Entity Type:Organization
Organization Name:BALDWIN PHARMACY LLC
Other - Org Name:BALDWIN PHARMACY LLC LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-677-3223
Mailing Address - Street 1:1667 WILLINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:GA
Mailing Address - Zip Code:30511
Mailing Address - Country:US
Mailing Address - Phone:706-778-7174
Mailing Address - Fax:706-778-3405
Practice Address - Street 1:1667 WILLINGHAM AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511
Practice Address - Country:US
Practice Address - Phone:706-778-7174
Practice Address - Fax:706-778-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175969AMedicaid