Healthcare Provider Details

I. General information

NPI: 1740954882
Provider Name (Legal Business Name): CODY ALEXANDER BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF LAMONT STREET AND VETERANS WAY
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

185 RIDGE POINTE DR
JOHNSON CITY TN
37604-4393
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone: 276-365-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number022169
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: