Provider Demographics
NPI:1396118873
Name:BAKER, DESIREE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:ESCHARDIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3208 2ND AVE N
Mailing Address - Street 2:STE 4
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3682
Mailing Address - Country:US
Mailing Address - Phone:561-651-9393
Mailing Address - Fax:561-530-4968
Practice Address - Street 1:3208 2ND AVE N
Practice Address - Street 2:STE 4
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3682
Practice Address - Country:US
Practice Address - Phone:561-651-9393
Practice Address - Fax:561-530-4968
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014788100Medicaid