Provider Demographics
NPI:1922544725
Name:BAKER, JASON (BS, PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:BS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1536
Mailing Address - Country:US
Mailing Address - Phone:502-741-6578
Mailing Address - Fax:888-789-5253
Practice Address - Street 1:200 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1536
Practice Address - Country:US
Practice Address - Phone:502-741-6578
Practice Address - Fax:888-789-5253
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist