Provider Demographics
NPI:1508104951
Name:BAKER, MICHAEL F (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:BAKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 N COBB PKWY
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3469
Mailing Address - Country:US
Mailing Address - Phone:770-426-3264
Mailing Address - Fax:770-792-9965
Practice Address - Street 1:2774 N COBB PKWY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3469
Practice Address - Country:US
Practice Address - Phone:770-426-3264
Practice Address - Fax:770-792-9965
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist