Healthcare Provider Details

I. General information

NPI: 1790062040
Provider Name (Legal Business Name): RICHARD DANIEL BALDWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 ADAMS ST
WINNSBORO LA
71295-2602
US

IV. Provider business mailing address

802 ADAMS ST
WINNSBORO LA
71295-2602
US

V. Phone/Fax

Practice location:
  • Phone: 318-435-7858
  • Fax: 318-435-7122
Mailing address:
  • Phone: 318-435-7858
  • Fax: 318-435-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11123
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: