Provider Demographics
NPI:1083946594
Name:BAKER, NICOLE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5612
Mailing Address - Country:US
Mailing Address - Phone:307-362-7990
Mailing Address - Fax:307-382-7873
Practice Address - Street 1:2450 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5612
Practice Address - Country:US
Practice Address - Phone:307-362-7990
Practice Address - Fax:307-382-7873
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist