Provider Demographics
NPI:1164722666
Name:BAKER, SANDRA JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
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 1:6200 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1359
Mailing Address - Country:US
Mailing Address - Phone:360-486-3401
Mailing Address - Fax:360-486-3403
Practice Address - Street 1:6200 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1359
Practice Address - Country:US
Practice Address - Phone:360-486-3401
Practice Address - Fax:360-486-3403
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist