Provider Demographics
NPI:1366748543
Name:BRADLEY-BAKER, LYNETTE R (RPH, PHD)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:R
Last Name:BRADLEY-BAKER
Suffix:
Gender:F
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1035
Mailing Address - Country:US
Mailing Address - Phone:301-974-7761
Mailing Address - Fax:
Practice Address - Street 1:31 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1035
Practice Address - Country:US
Practice Address - Phone:301-974-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist