Provider Demographics
NPI:1346534468
Name:BAKER, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 NE HALSEY ST
Mailing Address - Street 2:T-1406
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-8616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21500 NE HALSEY ST
Practice Address - Street 2:T-1406
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-8616
Practice Address - Country:US
Practice Address - Phone:503-491-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist