Provider Demographics
NPI:1487620324
Name:BAKER, MIKE J (RPH)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:J
Last Name:BAKER
Suffix:
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:PO BOX 4996
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4996
Mailing Address - Country:US
Mailing Address - Phone:423-569-6492
Mailing Address - Fax:
Practice Address - Street 1:905 BAKER HWY
Practice Address - Street 2:SUITE #1
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4163
Practice Address - Country:US
Practice Address - Phone:423-569-9355
Practice Address - Fax:423-663-3992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist