Provider Demographics
NPI:1962748533
Name:BAKER, BETTY W (RPH,MBA/MHA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:W
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH,MBA/MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-7000 KEWALO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2833
Mailing Address - Country:US
Mailing Address - Phone:808-324-0234
Mailing Address - Fax:
Practice Address - Street 1:74-5455 MAKALA BLVD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2727
Practice Address - Country:US
Practice Address - Phone:808-334-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-2357183500000X
GARPH013277183500000X
TX38475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist