Provider Demographics
NPI:1780163261
Name:BALDWIN, AMY MALAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MALAYNE
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 1:2490 LA PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7749
Mailing Address - Country:US
Mailing Address - Phone:559-799-4335
Mailing Address - Fax:
Practice Address - Street 1:1395 E PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-8053
Practice Address - Country:US
Practice Address - Phone:559-688-2992
Practice Address - Fax:559-688-6535
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist