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General NPI Number Information
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NPI Number | 1023138674
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Entity Type | Organization
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Legal Business Name | WILLIAM W BAKER
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 211 MAIN AVE
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City | COMANCHE
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State | OK
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Zip | 73529-1443
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Country | US
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Telephone | 580-439-8846
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Fax | 580-439-8846
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Provider Business Mailing Address
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Address Line | 211 MAIN AVE
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City | COMANCHE
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State | OK
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Zip | 73529-1443
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Country | US
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Telephone | 580-439-8846
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Fax | 580-439-8846
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Authorized Official
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Title or Position | OWNER AND RPH
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Name | BILL BAKER
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Credential | RPH
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Telephone | 580-439-8846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 135257
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License Number State | OK
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