Provider Demographics
NPI:1790752095
Name:BAKER, SANDRA E (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:E
Other - Last Name:PERCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14226 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2587
Mailing Address - Country:US
Mailing Address - Phone:813-767-2349
Mailing Address - Fax:
Practice Address - Street 1:7901 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3847
Practice Address - Country:US
Practice Address - Phone:813-936-9598
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist