Provider Demographics
NPI:1588643464
Name:BAKER, SCOTTY V (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:V
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:106 WEST HIGHWAY 62-412
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-0247
Mailing Address - Country:US
Mailing Address - Phone:870-895-3811
Mailing Address - Fax:870-895-2828
Practice Address - Street 1:106 WEST HIGHWAY 62-412
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-0247
Practice Address - Country:US
Practice Address - Phone:870-895-3811
Practice Address - Fax:870-895-2828
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPDO5833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist