Provider Demographics
NPI:1063599868
Name:BAKERS PHARMACY INC
Entity type:Organization
Organization Name:BAKERS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:HOOPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-364-5155
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-2928
Mailing Address - Country:US
Mailing Address - Phone:870-364-5155
Mailing Address - Fax:870-364-2712
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2928
Practice Address - Country:US
Practice Address - Phone:870-364-5155
Practice Address - Fax:870-364-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
ARAR022783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100610407Medicaid
1992900OtherPK