Provider Demographics
NPI:1366680910
Name:BAKER, JOHN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BAKER
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 1:392 DOHNER DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2137
Mailing Address - Country:US
Mailing Address - Phone:330-334-3517
Mailing Address - Fax:
Practice Address - Street 1:7835 FREEDOM AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-6907
Practice Address - Country:US
Practice Address - Phone:866-909-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist