Provider Demographics
NPI:1316985641
Name:BAKER, JOHN KEITH (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEITH
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 1:14371 DAWSON CT
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3674
Mailing Address - Country:US
Mailing Address - Phone:651-322-7104
Mailing Address - Fax:
Practice Address - Street 1:1299 PROMENADE PL
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2293
Practice Address - Country:US
Practice Address - Phone:651-209-2974
Practice Address - Fax:651-209-2979
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111759-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist