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NPI Code Detail

MEDICARE: D.L. BAKER DRUG CO., INC.

MEDICARE: D.L. BAKER DRUG CO., INC.
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
1183500000XPharmacistPD06101AR
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699789545
Entity Type Code : Organization
Provider Name (Legal Business Name) : D.L. BAKER DRUG CO., INC.
Provider Business Mailing Address
First Line : 4307 E BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-4124
Country : US
Telephone Number : 501-945-3264
Fax Number : 501-945-6976
Provider Business Practice Location Address
First Line : 4307 E BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-4124
Country : US
Telephone Number : 501-945-3264
Fax Number : 501-945-6976
Authorized Official
Title or Position : PHARMACIST/OWNER
Name : MR. RANDY ISSA KASSISSIEH
Credential : PHARMD
Telephone Number : 501-945-3264
Provider Enumeration Date : 07/28/2006
Last Update Date : 06/23/2022

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