MEDICARE: JEFFERY BAKER REG PHARMACIST

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	040004	MO

General Provider Information

NPI Number	:	1952548794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY BAKER REG PHARMACIST

Provider Business Mailing Address
First Line	:	4913 KARINGTON PLACE CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-7106
Country	:	US
Telephone Number	:	314-892-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 KARINGTON PLACE CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-7106
Country	:	US
Telephone Number	:	314-892-2511
Fax Number	:

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

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/17/2009

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