Provider Demographics
NPI:1063849206
Name:BAKER, JAMES BRIAN (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:BAKER
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 1:1675 WHITELEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:970-556-5331
Mailing Address - Fax:
Practice Address - Street 1:302 E AVENUE A
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:KS
Practice Address - Zip Code:67878-7098
Practice Address - Country:US
Practice Address - Phone:620-684-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11335183500000X
NE13606183500000X
CO14070183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist