=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366140154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2023
-----------------------------------------------------
Last Update Date | 02/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3821 MCCLAY RD STE B
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-7387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-324-9093
-----------------------------------------------------
Fax | 636-730-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11375 MOSLEY FOREST DR
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-324-9093
-----------------------------------------------------
Fax | 636-730-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JANE H BAE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 314-518-1410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------