Healthcare Provider Details

I. General information

NPI: 1922673482
Provider Name (Legal Business Name): GREATER BADEN MEDICAL SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 02/23/2024
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT ROAD SUITE 131
BRANDYWINE MD
20613
US

IV. Provider business mailing address

1620 W. NORTHWEST HWY SUITE 100
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 240-207-2970
  • Fax: 240-213-7091
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-572-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. WYNDY WEBB
Title or Position: CPO
Credential: PHARMD, MBA, PHD
Phone: 301-599-2172