Provider Demographics
NPI:1104138296
Name:BALDWIN, GREYDON G JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GREYDON
Middle Name:G
Last Name:BALDWIN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3531
Mailing Address - Country:US
Mailing Address - Phone:409-792-0597
Mailing Address - Fax:409-792-0052
Practice Address - Street 1:1790 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:TX
Practice Address - Zip Code:77611-3531
Practice Address - Country:US
Practice Address - Phone:409-792-0597
Practice Address - Fax:409-792-0052
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist