Healthcare Provider Details

I. General information

NPI: 1114201316
Provider Name (Legal Business Name): ANDREW M BAKER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 CALUMET AVE.
VALPARAISO IN
46383
US

IV. Provider business mailing address

1903 CALUMET AVE.
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-6172
  • Fax:
Mailing address:
  • Phone: 219-462-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020253A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: