Provider Demographics
NPI:1619065752
Name:BAKER, BECKY SUE (RPH)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 W BUTTERFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-9468
Mailing Address - Country:US
Mailing Address - Phone:269-763-3693
Mailing Address - Fax:
Practice Address - Street 1:127 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1830
Practice Address - Country:US
Practice Address - Phone:269-945-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist