Healthcare Provider Details

I. General information

NPI: 1023138674
Provider Name (Legal Business Name): WILLIAM W BAKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MAIN AVE
COMANCHE OK
73529-1443
US

IV. Provider business mailing address

211 MAIN AVE
COMANCHE OK
73529-1443
US

V. Phone/Fax

Practice location:
  • Phone: 580-439-8846
  • Fax: 580-439-8846
Mailing address:
  • Phone: 580-439-8846
  • Fax: 580-439-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number135257
License Number StateOK

VIII. Authorized Official

Name: BILL BAKER
Title or Position: OWNER AND RPH
Credential: RPH
Phone: 580-439-8846