Provider Demographics
NPI:1124244017
Name:BAKER, DONALD R (RPH)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SENATOR LN
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2621
Mailing Address - Country:US
Mailing Address - Phone:606-877-2328
Mailing Address - Fax:606-864-3127
Practice Address - Street 1:803 MEYERS BAKER RD STE 110
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3041
Practice Address - Country:US
Practice Address - Phone:606-877-1008
Practice Address - Fax:606-864-3127
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008444OtherPHARMACY LICENSE