Healthcare Provider Details

I. General information

NPI: 1003339318
Provider Name (Legal Business Name): EMILY ANN BAKER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LUNDORFF DR
SANDSTONE MN
55072-5051
US

IV. Provider business mailing address

2024 W CHUB LAKE RD
CARLTON MN
55718-8208
US

V. Phone/Fax

Practice location:
  • Phone: 320-245-5500
  • Fax: 320-245-5123
Mailing address:
  • Phone: 218-969-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number123449
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: