MEDICARE: DR. JACQUELINE 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	1-13155	LA

General Provider Information

NPI Number	:	1144860164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE BAKER PHARMD

Provider Business Mailing Address
First Line	:	8709 W 80TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-3305
Country	:	US
Telephone Number	:	913-302-0352
Fax Number	:	833-400-5433

Provider Business Practice Location Address
First Line	:	8709 W 80TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-3305
Country	:	US
Telephone Number	:	913-302-0352
Fax Number	:	833-400-5433

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

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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