Provider Demographics
NPI:1982036992
Name:BAKER, KAYLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RIDENOUR PL
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1600
Mailing Address - Country:US
Mailing Address - Phone:843-441-1578
Mailing Address - Fax:
Practice Address - Street 1:85 MATHEWS DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3609
Practice Address - Country:US
Practice Address - Phone:843-681-8363
Practice Address - Fax:843-681-7824
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist