Provider Demographics
NPI:1336420538
Name:BAKER, STEPHANIE J (RPH)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3006
Mailing Address - Country:US
Mailing Address - Phone:219-866-0466
Mailing Address - Fax:219-866-0456
Practice Address - Street 1:1000 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1446
Practice Address - Country:US
Practice Address - Phone:765-497-2300
Practice Address - Fax:765-497-2311
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019934A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019934AOtherSTATE LICENSE NUMBER