Healthcare Provider Details

I. General information

NPI: 1063849206
Provider Name (Legal Business Name): JAMES BRIAN BAKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E AVENUE A
SYRACUSE KS
67878-7098
US

IV. Provider business mailing address

1675 WHITELEY DRIVE
WINDSOR CO
80550
US

V. Phone/Fax

Practice location:
  • Phone: 620-684-7424
  • Fax:
Mailing address:
  • Phone: 970-556-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-11335
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13606
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: