Provider Demographics
NPI:1558590281
Name:BAKKER, THERESA D (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:D
Last Name:BAKKER
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MILL RD
Mailing Address - Street 2:UNIT G
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3046
Mailing Address - Country:US
Mailing Address - Phone:603-868-5221
Mailing Address - Fax:603-868-6595
Practice Address - Street 1:5 MILL RD
Practice Address - Street 2:UNIT G
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3046
Practice Address - Country:US
Practice Address - Phone:603-868-5221
Practice Address - Fax:603-868-6595
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3498183500000X
MEPR5561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist