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NPI Code Detail

MEDICARE: EUGENE BAKER DPH

MEDICARE:   EUGENE  BAKER  DPH
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
1183500000XPharmacist2854TN

General Provider Information

NPI Number : 1942518287
Entity Type Code : Individual
Provider Name (Legal Business Name) : EUGENE BAKER DPH
Provider Business Mailing Address
First Line : 155 JESSIE LN NW
Second Line :
City : CHARLESTON
State : TN
Zip : 37310-5119
Country : US
Telephone Number : 423-476-7449
Fax Number :
Provider Business Practice Location Address
First Line : 155 JESSIE LN NW
Second Line :
City : CHARLESTON
State : TN
Zip : 37310-5119
Country : US
Telephone Number : 423-476-7449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2010
Last Update Date : 09/21/2010

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Directions to “ EUGENE BAKER DPH” Practice Location

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