Provider Demographics
NPI:1306843016
Name:BAKER DRUG COMPANY
Entity Type:Organization
Organization Name:BAKER DRUG COMPANY
Other - Org Name:BAKER DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:501-329-5626
Mailing Address - Street 1:924 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4304
Mailing Address - Country:US
Mailing Address - Phone:501-329-5626
Mailing Address - Fax:501-329-1977
Practice Address - Street 1:924 FRONT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4304
Practice Address - Country:US
Practice Address - Phone:501-329-5626
Practice Address - Fax:501-329-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR021273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992895OtherPK
AR100179407Medicaid
AR100179407Medicaid