Provider Demographics
NPI:1144068024
Name:BALTIMORE, MARVIN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:BALTIMORE
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3372
Mailing Address - Country:US
Mailing Address - Phone:832-850-3254
Mailing Address - Fax:
Practice Address - Street 1:2817 SOUTHMORE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7707
Practice Address - Country:US
Practice Address - Phone:832-850-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home