Provider Demographics
NPI:1134730641
Name:BAKER, MEGHAN XANTHE (CPHT, PP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:XANTHE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CPHT, PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 WELLINGTON TER
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2361
Mailing Address - Country:US
Mailing Address - Phone:404-433-1392
Mailing Address - Fax:
Practice Address - Street 1:3530 WELLINGTON TER
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2361
Practice Address - Country:US
Practice Address - Phone:404-433-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC017024183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician