MEDICARE: TERESA BAKER

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	3336C0003X	Community/Retail Pharmacy	S023571	AZ

General Provider Information

NPI Number	:	1942783527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA BAKER

Provider Business Mailing Address
First Line	:	2140 E BASELINE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6910
Country	:	US
Telephone Number	:	602-281-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 E BASELINE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6910
Country	:	US
Telephone Number	:	602-281-1120
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “ TERESA BAKER ” Practice Location

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