Provider Demographics
NPI:1407296452
Name:BAKER, KEVIN FREDRICK JR
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FREDRICK
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LARKIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6214
Mailing Address - Country:US
Mailing Address - Phone:207-227-9620
Mailing Address - Fax:
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6572
Practice Address - Country:US
Practice Address - Phone:207-338-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist