Provider Demographics
NPI:1922334655
Name:BAKER, MICHAEL ANTHONY (PHARMD, CERT IMM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARMD, CERT IMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W IOWA AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6815
Mailing Address - Country:US
Mailing Address - Phone:208-855-0701
Mailing Address - Fax:208-268-6301
Practice Address - Street 1:222 W IOWA AVE STE 225
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6815
Practice Address - Country:US
Practice Address - Phone:208-855-0701
Practice Address - Fax:208-268-6301
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP58811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist