Provider Demographics
NPI:1609994995
Name:BAKER, CHADWICK M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:M
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7578
Mailing Address - Country:US
Mailing Address - Phone:704-882-5976
Mailing Address - Fax:704-540-5912
Practice Address - Street 1:15221 JOHN J DELANEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2742
Practice Address - Country:US
Practice Address - Phone:704-540-5561
Practice Address - Fax:704-540-5912
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist