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General NPI Number Information
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NPI Number | 1689219917
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Entity Type | Organization
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Legal Business Name | BAKER PHARMACY LLC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 698 W MACCLENNY AVE STE 682
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City | MACCLENNY
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State | FL
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Zip | 32063-2092
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Country | US
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Telephone | 904-314-3288
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Fax |
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Provider Business Mailing Address
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Address Line | 698 W MACCLENNY AVE STE 682
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City | MACCLENNY
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State | FL
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Zip | 32063-2092
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Country | US
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Telephone | 904-314-3288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAVANKUMAR BANOTH
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Credential |
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Telephone | 904-314-3288
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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 |
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License Number State |
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