MEDICARE: DR. CHEZKA MAE LARGOSA BAKER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S024556	AZ

General Provider Information

NPI Number	:	1063037554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHEZKA MAE LARGOSA BAKER PHARMD

Provider Business Mailing Address
First Line	:	800 N CENTRAL AVE APT 1218
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2777
Country	:	US
Telephone Number	:	804-982-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 N CENTRAL AVE APT 1218
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2777
Country	:	US
Telephone Number	:	804-982-8727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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