Provider Demographics
NPI:1346492162
Name:BAKER, NATHAN (PHARM-D)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8817
Mailing Address - Country:US
Mailing Address - Phone:509-524-7520
Mailing Address - Fax:509-526-6549
Practice Address - Street 1:1313 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8817
Practice Address - Country:US
Practice Address - Phone:509-524-7520
Practice Address - Fax:509-526-6549
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00052633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist