Provider Demographics
NPI:1336339563
Name:BAKER, EZEKIEL MONTRAVILLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:MONTRAVILLE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 HEIMAN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2407
Mailing Address - Country:US
Mailing Address - Phone:256-453-4908
Mailing Address - Fax:615-866-6293
Practice Address - Street 1:1410 DONELSON PIKE STE B6
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2952
Practice Address - Country:US
Practice Address - Phone:615-866-6292
Practice Address - Fax:615-866-6293
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021469183500000X
MD23922183500000X
GA023693183500000X
MI5302044430183500000X
AZ016117183500000X
TN33488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist