MEDICARE: JACQUELINE PIERICK BAKER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302038918	MI
2	1835G0303X	Geriatric Pharmacist	5302038918	MI

General Provider Information

NPI Number	:	1326474123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE PIERICK BAKER PHARMD

Provider Business Mailing Address
First Line	:	634 BERTINA LN
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 S GARFIELD AVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-4338
Country	:	US
Telephone Number	:	231-941-8432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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