Provider Demographics
NPI:1942518287
Name:BAKER, EUGENE (DPH)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:155 JESSIE LN NW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:TN
Mailing Address - Zip Code:37310-5119
Mailing Address - Country:US
Mailing Address - Phone:423-476-7449
Mailing Address - Fax:
Practice Address - Street 1:155 JESSIE LN NW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:TN
Practice Address - Zip Code:37310-5119
Practice Address - Country:US
Practice Address - Phone:423-476-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist