Provider Demographics
NPI:1508945502
Name:BAKER DRUG
Entity Type:Organization
Organization Name:BAKER DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-778-2214
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0459
Mailing Address - Country:US
Mailing Address - Phone:406-778-2214
Mailing Address - Fax:406-778-2247
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313
Practice Address - Country:US
Practice Address - Phone:406-778-2214
Practice Address - Fax:406-778-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0121710Medicaid