Provider Demographics
NPI:1558790410
Name:BAKER DRUG LLC
Entity Type:Organization
Organization Name:BAKER DRUG LLC
Other - Org Name:STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R,PH
Authorized Official - Prefix:MR
Authorized Official - First Name:GAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-741-6266
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:118 E. ROLLA STREET
Mailing Address - City:HARTVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65667-0056
Mailing Address - Country:US
Mailing Address - Phone:417-741-6266
Mailing Address - Fax:417-741-1616
Practice Address - Street 1:118 E. ROLLA STREET
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:MO
Practice Address - Zip Code:65667-0056
Practice Address - Country:US
Practice Address - Phone:417-741-6266
Practice Address - Fax:417-741-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039922333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy