Healthcare Provider Details

I. General information

NPI: 1922334655
Provider Name (Legal Business Name): MICHAEL ANTHONY BAKER PHARMD, CERT. IMM.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2009
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S INDUSTRY WAY STE 240
MERIDIAN ID
83642-3559
US

IV. Provider business mailing address

222 W IOWA AVE STE 225
NAMPA ID
83686-6815
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-0669
  • Fax: 208-955-3291
Mailing address:
  • Phone: 208-855-0701
  • Fax: 208-268-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberP5881
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP5881
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: