Healthcare Provider Details

I. General information

NPI: 1548567985
Provider Name (Legal Business Name): RICK BALDWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 BROAD RIVER RD
IRMO SC
29063-9662
US

IV. Provider business mailing address

7412 BROAD RIVER RD
IRMO SC
29063-9662
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-3046
  • Fax:
Mailing address:
  • Phone: 803-749-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5027
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: