1639155047 NPI number — DR. KATHY BALDWIN PHARM D

Table of content: DR. KATHY BALDWIN PHARM D (NPI 1639155047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639155047 NPI number — DR. KATHY BALDWIN PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWIN
Provider First Name:
KATHY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639155047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11430 SHIPWATCH LANE # 1051
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-486-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
LAKELAND REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-687-1100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PS 22130 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)