Provider Demographics
NPI:1053629170
Name:BAKER, MICHAEL PHILLIP (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILLIP
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 1:772 MAIN ST # 1570
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-4533
Mailing Address - Country:US
Mailing Address - Phone:304-855-4541
Mailing Address - Fax:304-855-4355
Practice Address - Street 1:772 MAIN ST # 1570
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-4533
Practice Address - Country:US
Practice Address - Phone:304-855-4541
Practice Address - Fax:304-855-4355
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist