Provider Demographics
NPI:1992984199
Name:BAKO, EDWARD (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:BAKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 BUSINESS PARK BLVD
Mailing Address - Street 2:BUILDING L, SUITE 24
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7119
Mailing Address - Country:US
Mailing Address - Phone:907-334-2654
Mailing Address - Fax:907-561-1684
Practice Address - Street 1:4501 BUSINESS PARK BLVD
Practice Address - Street 2:BUILDING L, SUITE 24
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7119
Practice Address - Country:US
Practice Address - Phone:907-334-2654
Practice Address - Fax:907-561-1684
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1514183500000X
OH03-1-20810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist