Healthcare Provider Details

I. General information

NPI: 1124393616
Provider Name (Legal Business Name): BAIDEN GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 SMITH AVE STE A
ACTON CA
93510-2500
US

IV. Provider business mailing address

3630 SMITH AVE STE A
ACTON CA
93510-2500
US

V. Phone/Fax

Practice location:
  • Phone: 661-269-9911
  • Fax: 661-269-9915
Mailing address:
  • Phone: 661-269-9911
  • Fax: 661-269-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50825
License Number StateCA

VIII. Authorized Official

Name: AMMA AMIHYIA
Title or Position: OWNER
Credential:
Phone: 661-269-9911