Provider Demographics
NPI:1609968981
Name:BAIRD, JOHN WALTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WALTER
Last Name:BAIRD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2018
Mailing Address - Country:US
Mailing Address - Phone:423-784-6226
Mailing Address - Fax:423-784-2947
Practice Address - Street 1:229 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2018
Practice Address - Country:US
Practice Address - Phone:423-784-6226
Practice Address - Fax:423-784-2947
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist