Provider Demographics
NPI:1871811224
Name:BALDWIN, PATRICK BOWLER (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BOWLER
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 YALE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3722
Mailing Address - Country:US
Mailing Address - Phone:757-838-2064
Mailing Address - Fax:
Practice Address - Street 1:210 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2513
Practice Address - Country:US
Practice Address - Phone:757-722-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist