Provider Demographics
NPI:1023138674
Name:WILLIAM W BAKER
Entity type:Organization
Organization Name:WILLIAM W BAKER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND RPH
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-439-8846
Mailing Address - Street 1:211 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73529-1443
Mailing Address - Country:US
Mailing Address - Phone:580-439-8846
Mailing Address - Fax:580-439-8846
Practice Address - Street 1:211 MAIN AVE
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529-1443
Practice Address - Country:US
Practice Address - Phone:580-439-8846
Practice Address - Fax:580-439-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1352573336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073599OtherPK
OK200125600AMedicaid
OK100234410AMedicaid
OK6054490001Medicare NSC