Provider Demographics
NPI:1164866752
Name:JOHN R BAIRD MD PLLC
Entity Type:Organization
Organization Name:JOHN R BAIRD MD PLLC
Other - Org Name:ADVANCED RX PHARMACY 022
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-621-2902
Mailing Address - Street 1:4683 CHABOT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3830
Mailing Address - Country:US
Mailing Address - Phone:925-621-2902
Mailing Address - Fax:925-522-2930
Practice Address - Street 1:3012 EASTPOINT PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4185
Practice Address - Country:US
Practice Address - Phone:502-339-6550
Practice Address - Fax:502-379-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139992OtherPK