MEDICARE: NORTH BALDWIN FAMILY PHARMACY, LLC,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	4305	AL
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780650911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BALDWIN FAMILY PHARMACY, LLC,

Provider Business Mailing Address
First Line	:	2012 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4115
Country	:	US
Telephone Number	:	251-937-9623
Fax Number	:	251-937-2250

Provider Business Practice Location Address
First Line	:	2012 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4115
Country	:	US
Telephone Number	:	251-937-9623
Fax Number	:	251-937-2250

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. JANET GREEN CHASTANG
Credential	:	RPH
Telephone Number	:	251-937-9623

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/23/2022

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