Provider Demographics
NPI:1477603835
Name:BAKERS PHARMACY
Entity Type:Organization
Organization Name:BAKERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUPENUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-742-3149
Mailing Address - Street 1:29 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1249
Mailing Address - Country:US
Mailing Address - Phone:217-742-3149
Mailing Address - Fax:217-742-5219
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1249
Practice Address - Country:US
Practice Address - Phone:217-742-3149
Practice Address - Fax:217-742-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054071293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy