Provider Demographics
NPI:1609947068
Name:MICHAEL BAKER PHARMACY, INC.
Entity Type:Organization
Organization Name:MICHAEL BAKER PHARMACY, INC.
Other - Org Name:BAKER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-448-3336
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650
Mailing Address - Country:US
Mailing Address - Phone:870-448-3336
Mailing Address - Fax:870-448-3335
Practice Address - Street 1:101 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650
Practice Address - Country:US
Practice Address - Phone:870-448-3336
Practice Address - Fax:870-448-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 333600000X
ARAR202293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139262407Medicaid
1995262OtherPK