Provider Demographics
NPI:1710025705
Name:BAKERS PHARMACY INC
Entity Type:Organization
Organization Name:BAKERS PHARMACY INC
Other - Org Name:BAKERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:502-535-4466
Mailing Address - Street 1:3399 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAMPING GROUND
Mailing Address - State:KY
Mailing Address - Zip Code:40379-9081
Mailing Address - Country:US
Mailing Address - Phone:502-535-4466
Mailing Address - Fax:502-535-4591
Practice Address - Street 1:3399 MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMPING GROUND
Practice Address - State:KY
Practice Address - Zip Code:40379-9081
Practice Address - Country:US
Practice Address - Phone:502-535-4466
Practice Address - Fax:502-535-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP021453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54023791Medicaid
2031455OtherPK