Provider Demographics
NPI:1194938019
Name:BAKER, RANDY L (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:L
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 1:20102 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5881
Mailing Address - Country:US
Mailing Address - Phone:352-489-5575
Mailing Address - Fax:
Practice Address - Street 1:184 MARION OAKS DR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473
Practice Address - Country:US
Practice Address - Phone:352-347-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1068940OtherNABP