Provider Demographics
NPI:1174640676
Name:BAKER, GARY D (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 HOSPITAL DRIVE
Mailing Address - Street 2:P.O. BOX 760
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417
Mailing Address - Country:US
Mailing Address - Phone:406-338-6108
Mailing Address - Fax:406-338-6351
Practice Address - Street 1:760 HOSPITAL AVE.
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6108
Practice Address - Fax:406-338-6351
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210052Medicaid
MT270074Medicare ID - Type Unspecified