Healthcare Provider Details

I. General information

NPI: 1154085918
Provider Name (Legal Business Name): IAN BAKER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 04/29/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LANDSTHUL
APO AE
09180-3100
US

IV. Provider business mailing address

UNIT 33100 BOX LANDSTHUL
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-5059
  • Fax:
Mailing address:
  • Phone: 314-566-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208208
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: