Provider Demographics
NPI:1487930087
Name:BAKER, LORI R (PHARMD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WEIGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1106 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6124
Mailing Address - Country:US
Mailing Address - Phone:715-852-0063
Mailing Address - Fax:715-852-0072
Practice Address - Street 1:1106 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6124
Practice Address - Country:US
Practice Address - Phone:715-852-0063
Practice Address - Fax:715-852-0072
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15627-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.294180OtherREGISTERED PHARMACIST