Healthcare Provider Details

I. General information

NPI: 1639851611
Provider Name (Legal Business Name): LILA BAKER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NW 43RD ST
GAINESVILLE FL
32606-4484
US

IV. Provider business mailing address

2508 SW 35TH PL UNIT B9
GAINESVILLE FL
32608-3252
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-0585
  • Fax:
Mailing address:
  • Phone: 813-369-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS65964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: