Provider Demographics
NPI:1982360061
Name:BALDWIN, SEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 E RUSSELL AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2165
Mailing Address - Country:US
Mailing Address - Phone:920-279-6801
Mailing Address - Fax:
Practice Address - Street 1:7707 94TH AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1955
Practice Address - Country:US
Practice Address - Phone:262-597-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19934-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist